Patent Abstract:
multiple rib fractures in trauma patients are associated with significant morbidity and mortality . delayed morbidity for patients with rib fractures is often a result of hypoventilation leading to atelectasis , pneumonia and respiratory failure . pain management was first recognized as an important factor in preventing complications in these patients . later , management of the respiratory system became more widely recognized as a major factor in , patients &# 39 ; care . it is now known that patients with multiple rib fractures benefit most from adequate pain control , rapid mobilization , and meticulous respiratory care to prevent complications . a rib fracture score and protocol based on a synthesis of the existing literature is developed . the protocol is directed to decisions about rapid mobilization , respiratory support , and pain management interventions to decrease the length of patients &# 39 ; stay in intensive care units .

Detailed Description:
on the basis of the ziegler and argarwal data previously mentioned and the finding of other investigators , the protocol of the present invention was developed for a quality improvement project in a 10 - bed trauma unit in a community hospital in the midwestern united states . the information obtained from the project was used to develop a formula for determining which patients are at highest risk and thus which level of care is indicated . the levels of care are conservative , progressive , aggressive , and emergent . a review of literature led to the inclusion of 3 major components of management in the protocol : pain control , respiratory support , and rapid mobilization of the patient . roumen et al . [ 38 ] found that scoring systems directly grading the injury severity of groups of trauma patients have predictive value for late and remote complications , such as ards and multiple organ failure , whereas scoring systems that grade the physiologic response to trauma have no predictive value but are related to mortality . for this reason , the injury severity score was not selected for use in this protocol . rather , looking specifically at the number of ribs fractured and differentiating unilateral versus bilateral injury seemed prudent . when this protocol is followed , specific care should be implemented in adult trauma patients with chest injuries with a rib fracture score greater than 6 . the simple formula shown in table 1 following can be used to ascertain the rib fracture score : rib fracture score = number of breaks ( 1 rib broken twice is 2 breaks ) multiplied by the number of sides the injury occurs on , ( unilateral is × 1 , bilateral is × 2 ) plus an age factor based on the age of the patient . the age factor is a calculation to accommodate for the increased risk of complications from injuries in the elderly [ 12 ]. as shown in fig2 an increasingly progressive protocol is based on the rib fracture score as a decision - making tool to provide adequate pain control , minimize complications , and to promote faster recovery from rib injuries in the expensive environment of intensive care units . the protocol suggests conservative , progressive , aggressive or emergent methods as shown in fig2 for pain management , respiratory management and activity / mobility depending on the rib fracture score . conservative methods are suggested for a rib fracture score of 3 - 6 , progressive methods for a score of 7 - 10 , aggressive methods for a score of 11 - 15 and emergent methods for a score greater than 15 . the present invention has been described with reference to certain preferred and alternative embodiments that are intended to be exemplary only and not limiting to the full scope of the present invention as set forth in the appended claims . 1 . honick d , sinert r . fractures , rib . in : emed j [ online serial ]. feb . 17 , 2001 , vol . 2 , no . 2 . available at : http : www . emedicine . com / emerg / topic 204 . htm . accessed jun . 1 , 2001 . 2 . gabram s g , schwartz r j , jacobs l m , et al . clinical management of blunt trauma patients with unilateral rib fractures : a randomized trial . world j surg . 1995 ; 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