Article Figures & Data
Tables
CHARACTERISTICS TOTAL (N = 447), N (%) ADMITTED (N = 23), N (%) DISCHARGED (N = 24), N (%) PVALUE Hospital • HEJ 237 (53.0) 3 (13.0) 234 (55.2) • HDL 144 (32.2) 10 (43.5) 134 (31.6) < .001 • CHUL 66 (14.8) 10 (43.5) 56 (13.2) Men 300 (67.6) 13 (59.1) 287 (67.7) NS Age • ≥ 65 y 125 (28.0) 17 (73.9) 108 (25.5) < .001 • ≥ 45 y 323 (72.3) 18 (78.7) 305 (71.9) NS Past medical history* • CAD 51 (11.4) 10 (43.4) 41 (9.7) < .001 • COPD 41 (9.2) 6 (26.1) 35 (8.3) .004 • Heart failure 15 (3.4) 3 (13.0) 11 (2.6) .003 • Osteoporosis 33 (7.4) 4 (13.0) 29 (6.4) .06 • Diabetes 41 (9.2) 5 (21.7) 36 (8.5) .03 Medication • Antiplatelets 86 (19.2) 9 (39.1) 77 (18.2) .01 • Anticoagulants 10 (2.2) 0 (0) 10 (2.4) NS Delay from trauma to ED consultation† • < 24 h 254 (56.8) 19 (86.3) 235 (56.2) • 24 to < 48 h 33 (7.4) 0 (0) 33 (7.8) .02 • ≥ 48 h 154 (34.5) 3 (13.6) 151 (36.9) Injury mechanism† • Fall from the patient’s own height 193 (45.0) 11 (50.0) 182 (44.6) • Fall from greater than the patient’s own height 88 (20.5) 4 (18.6) 84 (20.6) • MVC 49 (11.4) 4 (18.6) 45 (11.0) NS • Pedestrian and MVC 4 (0.9) 1 (4.5) 3 (0.7) • Direct blunt injury 72 (16.8) 1 (4.5) 71 (17.1) • Other 23 (5.4) 1 (4.5) 22 (15.4) Abnormal initial ED vital signs • Tachypnea (≥ 24 breaths/min) 35 (7.7) 5 (21.7) 30 (7.0) .02 • Oxygen saturation (≤ 92%) 75 (16.8) 6 (26.7) 69 (16.4) NS • Tachycardia (≥ 100 beats/min) 42 (9.5) 3 (13.6) 39 (9.2) NS No. of rib fractures on ED radiographs† • 1 111 (25.0) 2 (8.7) 109 (25.9) • 2 82 (18.5) 2 (8.7) 80 (18.9) .001 • 3 42 (9.5) 4 (18.2) 38 (9.1) • ≥ 4 34 (7.7) 13 (56.5) 21 (5.0) • Clinical diagnosis (ie, no rib fractures on x-ray scans) 175 (39.4) 2 (9.0) 173 (41.2) -
CAD—coronary artery disease, CHUL—Centre Hospitalier de l’Université Laval, COPD—chronic obstructive pulmonary disease, ED—emergency department, HDL—Hôtel-Dieu de Lévis, HEJ—Hôpital de l’Enfant-Jésus, MVC—motor vehicle collision, NS—not significant.
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↵* Smoking habits (current, past, or never) were not significantly associated with admission (data omitted for clarity).
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↵† Missing data were noted on chart review for injury mechanism, delay from trauma to ED consultation, and number of rib fractures on ED radiographs.
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- Table 2.
Characteristics of and follow-up recommendations for discharged patients, stratified by hospital: All statistical analyses were not significant.
CHARACTERISTICS AND RECOMMENDATIONS HEJ (N = 234), N (%) HDL (N =134), N (%) CHUL (N = 56), N (%) Age • ≥ 65 y 57 (24.4) 38 (28.3) 13 (23.2) • ≥ 45 y 167 (71.3) 100 (74.6) 38 (67.8) Past medical history • CAD 16 (6.8) 19 (14.1) 6 (10.7) • COPD 27 (11.5) 7 (5.2) 1 (1.8) • Diabetes 10 (10.6) 9 (6.7) 2 (3.6) No. of rib fractures on ED radiographs* • 1 64 (27.6) 28 (21.1) 17 (30.3) • 2 46 (19.8) 23 (17.2) 11 (19.6) • 3 21 (9.1) 12 (9.0) 5 (8.9) • ≤ 4 14 (6.0) 7 (5.3) 0 • Clinical diagnosis (ie, no rib fractures on x-ray scans) 87 (37.5) 63 (47.4) 23 (41.1) Injury mechanism* • Fall from the patient’s own height 103 (44.9) 52 (41.9) 27 (50.0) • Fall from greater than the patient’s own height 48 (21.0) 28 (22.6) 8 (14.8) • MVC 26 (11.3) 13 (10.5) 6 (11.1) • Pedestrian and MVC 2 (0.9) 1 (0.8) 0 • Direct blunt injury 37 (16.2) 25 (20.1) 9 (16.7) • Other 13 (5.7) 5 (4.0) 4 (7.4) Follow-up recommendations† • Come back if there are any red flag symptoms 79 (33.6) 47 (33.1) 13 (20.3) • Go see family doctor 31 (13.2) 22 (15.5) 12 (18.8) • Surgical consultation 3 (1.8) • No recommendation 123 (52.3) 78 (54.7) 35 (54.7) -
CAD—coronary artery disease, CHUL—Centre Hospitalier de l’Université Laval, COPD—chronic obstructive pulmonary disease, ED—emergency department, HDL—Hôtel-Dieu de Lévis, HEJ—Hôpital de l’Enfant-Jésus, MVC—motor vehicle collision.
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↵* Missing data were noted on chart review for injury mechanism and number of rib fractures on ED radiographs.
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↵† Patients might have had more than 1 recommendation noted during review.
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- Table 3.
Medical recommendations made to discharged patients, according to age and the number of fractured ribs
SPECIFIC HIGH-RISK SUBGROUP OF DISCHARGED ED PATIENTS N RECOMMENDATIONS, N (%)* COME BACK IF THERE ARE ANY RED FLAG SYMPTOMS† GO SEE FAMILY DOCTOR PLANNED ED FOLLOW-UP NO RECOMMENDATION‡§ Age • ≤ 64 y 322 111 (34.5) 49 (15.2) 22 (6.8) 161 (50.0) • ≥ 65 y 125 31 (24.8) 17 (13.6) 3 (2.4) 77 (61.6) No. of rib fractures on initial ED radiographs • 0 173 52 (29.7) 22 (12.5) 7 (7.9) 98 (55.7) • 1 109 39 (35.1) 17 (15.3) 8 (7.2) 54 (48.7) • 2 80 33 (40.2) 14 (17.2) 6 (7.3) 40 (48.8) • 3 38 14 (33.3) 19 (21.4) 4 (9.5) 17 (40.3) • ≥ 4 21 3 (8.8) 4 (11.8) 0 27 (79.4) - Table 4.
Analgesia prescribed in ED and at discharge in total sample (N = 447) and geriatric subgroup (N = 125)
TIME OF PRESCRIPTION PRESCRIBED ANALGESIA ACETAMINOPHEN, N (%) NSAIDS, N (%) OPIOIDS, N (%) ICE, N (%) NONE, (%) In ED • Age ≥ 65 y 39 (31.2) 7 (5.6)* 52 (41.6) 0 65 (52.0) • All 129 (28.9) 70 (15.7) 168 (37.6) 1 (0.2) 246 (55.0) At discharge • Age ≥ 65 y 65 (52.0) 18 (14.4)† 18 (14.4) 6 (4.8) 29 (23.3) • All 249 (55.7) 139 (31.1) 139 (31.1) 25 (5.6) 91 (20.4) NO. OF FRACTURED RIBS N PRESCRIBED ANALGESIA ACETAMINOPHEN, N(%) NSAIDS, N (%) OPIOIDS, N (%) ICE, N (%) NONE, N (%) No. of fractured ribs in ED* • 0 175 33 (18.9) 21 (12.0) 52 (29.7) 1 (0.1) 113 (64.6) • 1 111 30 (27.0) 14 (12.6) 33 (29.7) 70 (63.1) • 2 82 35 (42.6) 17 (20.7) 37 (45.1) 36 (43.9) • ≥ 3 76 30 (39.5) 18 (23.6) 46 (60.5) 25 (32.9) No. of fractured ribs at discharge* • 0 173 89 (51.4) 64 (36.9) 109 (63.0) 8 (4.6) 32 (18.5) • 1 109 72 (67.3) 34 (31.8) 76 (71.0) 12 (11.2) 19 (17.8) • 2 80 58 (73.4) 26 (32.9) 61 (77.2) 1 (1.3) 8 (10.1) -
ED—emergency department, NSAID—nonsteroidal anti-inflammatory drug.
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↵* χ2 P value was < .05 except for ice. Intercostal block was not used in significant proportions of patients (≤ 5).
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