Abstract：
Predicting rib fracture patients that will require higher-level care is a challenge during patient triage. Percentage of predicted forced vital capacity (FVC%) incorporates patient-specific factors to customize the measurements to each patient. A single institution transitioned from a clinical practice guideline (CPG) using absolute forced vital capacity (FVC) to one using FVC% to improve triage of rib fracture patients. This study compares the outcomes of patients before and after the CPG change.
A review of rib fracture patients was performed over a 3-year retrospective period (RETRO) and 1-year prospective period (PRO). RETRO patients were triaged by absolute FVC. Percentage of predicted FVC was used to triage PRO patients. Demographics, mechanism, Injury Severity Score, chest Abbreviated Injury Scale score, number of rib fractures, tube thoracostomy, intubation, admission to intensive care unit (ICU), transfer to ICU, hospital length of stay (LOS), ICU LOS, and mortality data were compared. A multivariable model was constructed to perform adjusted analysis for LOS.
There were 588 patients eligible for the study, with 269 RETRO and 319 PRO patients. No significant differences in age, gender, or injury details were identified. Fewer tube thoracostomy were performed in PRO patients. Rates of intubation, admission to ICU, and mortality were similar. The PRO cohort had fewer ICU transfers and shorter LOS and ICU LOS. Multivariable logistic regression identified a 78% reduction in odds of ICU transfer among PRO patients. Adjusted analysis with multiple linear regression showed LOS was decreased 1.28 days by being a PRO patient in the study (B = -1.44; p < 0.001) with R2 = 0.198.
Percentage of predicted FVC better stratified rib fracture patients leading to a decrease in transfers to the ICU, ICU LOS, and hospital LOS. By incorporating patient-specific factors into the triage decision, the new CPG optimized triage and decreased resource utilization over the study period.
Therapeutic/Care Management. Trauma, Rib, Triage, level IV.
A review of rib fracture patients was performed over a 3-year retrospective period (RETRO) and 1-year prospective period (PRO). RETRO patients were triaged by absolute FVC. Percentage of predicted FVC was used to triage PRO patients. Demographics, mechanism, Injury Severity Score, chest Abbreviated Injury Scale score, number of rib fractures, tube thoracostomy, intubation, admission to intensive care unit (ICU), transfer to ICU, hospital length of stay (LOS), ICU LOS, and mortality data were compared. A multivariable model was constructed to perform adjusted analysis for LOS.
There were 588 patients eligible for the study, with 269 RETRO and 319 PRO patients. No significant differences in age, gender, or injury details were identified. Fewer tube thoracostomy were performed in PRO patients. Rates of intubation, admission to ICU, and mortality were similar. The PRO cohort had fewer ICU transfers and shorter LOS and ICU LOS. Multivariable logistic regression identified a 78% reduction in odds of ICU transfer among PRO patients. Adjusted analysis with multiple linear regression showed LOS was decreased 1.28 days by being a PRO patient in the study (B = -1.44; p < 0.001) with R2 = 0.198.
Percentage of predicted FVC better stratified rib fracture patients leading to a decrease in transfers to the ICU, ICU LOS, and hospital LOS. By incorporating patient-specific factors into the triage decision, the new CPG optimized triage and decreased resource utilization over the study period.
Therapeutic/Care Management. Trauma, Rib, Triage, level IV.
摘要：
在患者分诊期间，预测需要更高水平护理的肋骨骨折患者是一个挑战。预测的强制肺活量的百分比(FVC%)结合了患者特定的因素以针对每个患者定制测量。单一机构从使用绝对强制肺活量（FVC）的临床实践指南（CPG）过渡到使用FVC％的机构，以改善肋骨骨折患者的分诊。这项研究比较了CPG改变前后患者的预后。
对肋骨骨折患者进行了为期3年的回顾性研究（RETRO）和1年的前瞻性研究（PRO）。RETRO患者按绝对FVC分类。预测的FVC百分比用于分诊PRO患者。人口统计,机制，伤害严重程度评分,胸部缩写损伤量表评分,肋骨骨折数,管状胸廓造口术,插管,入住重症监护病房(ICU)，转移到ICU,住院时间（LOS），ICULOS,和死亡率数据进行了比较。建立多变量模型对LOS进行调整分析。
有588名符合研究条件的患者，269RETRO和319PRO患者。年龄无显著差异,性别,或者确定了伤害细节。PRO患者进行的导管胸造口术较少。插管率,入住ICU,和死亡率相似。PRO队列的ICU转移较少，LOS和ICULOS较短。多变量逻辑回归确定PRO患者中ICU转移的几率降低了78%。多元线性回归的调整分析显示，作为研究中的PRO患者，LOS降低了1.28天（B=-1.44；p<0.001），R2=0.198。
预测的FVC较好的分层肋骨骨折患者的百分比导致转移到ICU的减少，ICULOS,医院LOS通过将患者特定因素纳入分诊决策，新的CPG优化了分诊，并在研究期间降低了资源利用率。
治疗/护理管理。创伤,肋骨,Triage,四级。
对肋骨骨折患者进行了为期3年的回顾性研究（RETRO）和1年的前瞻性研究（PRO）。RETRO患者按绝对FVC分类。预测的FVC百分比用于分诊PRO患者。人口统计,机制，伤害严重程度评分,胸部缩写损伤量表评分,肋骨骨折数,管状胸廓造口术,插管,入住重症监护病房(ICU)，转移到ICU,住院时间（LOS），ICULOS,和死亡率数据进行了比较。建立多变量模型对LOS进行调整分析。
有588名符合研究条件的患者，269RETRO和319PRO患者。年龄无显著差异,性别,或者确定了伤害细节。PRO患者进行的导管胸造口术较少。插管率,入住ICU,和死亡率相似。PRO队列的ICU转移较少，LOS和ICULOS较短。多变量逻辑回归确定PRO患者中ICU转移的几率降低了78%。多元线性回归的调整分析显示，作为研究中的PRO患者，LOS降低了1.28天（B=-1.44；p<0.001），R2=0.198。
预测的FVC较好的分层肋骨骨折患者的百分比导致转移到ICU的减少，ICULOS,医院LOS通过将患者特定因素纳入分诊决策，新的CPG优化了分诊，并在研究期间降低了资源利用率。
治疗/护理管理。创伤,肋骨,Triage,四级。
