Patient Reported Outcomes 6-12 months after Isolated Rib Fractures: A Non-Trivial Injury Pattern.

BACKGROUND Despite the ubiquity of rib fractures in patients with blunt chest trauma, long-term outcomes for patients with this injury pattern are not well described. METHODS The Functional Outcomes and Recovery after Trauma Emergencies (FORTE) project has established a multi-center prospective registry with 6 to 12-month follow-up for trauma patients treated at participating centers. We combined the FORTE registry with a detailed retrospective chart review investigating admission variables and injury characteristics. All trauma survivors with complete FORTE data and isolated chest trauma (AIS ≤ 1 in all other regions) with rib fractures were included. Outcomes included chronic pain, limitation in activities of daily living, physical limitations, exercise limitations, return to work, and both inpatient and discharge pain control modalities. Multivariable logistic regression models were built for each outcome using clinically relevant demographic and injury characteristic univariate predictors. RESULTS We identified 279 patients with isolated rib fractures. The median age of the cohort was 68 years (IQR 56-78), 59% were male, and 84% were white. Functional and quality of life limitations were common amongst survivors of isolated rib fractures even 6-12 months after injury. 43% of patients without a pre-existing pain disorder reported new daily pain, and new chronic pain was associated with low resilience. Limitations in physical functioning and exercise capacity were reported in 56% and 51% of patients, respectively. Of those working pre-injury, 28% had not returned to work. New limitations in activities of daily living were reported in 29% of patients over the age of 65. Older age, higher number of rib fractures, and ICU admission were independently associated with higher odds of receiving regional anesthesia. Receiving a regional nerve block did not have a statistically significant association with any patient-reported outcome measures. CONCLUSIONS Isolated rib fractures are a non-trivial trauma burden associated with functional impairment and chronic pain even 6-12 months after injury. LEVEL OF EVIDENCE Prognostic/epidemiologic, level III.