Abstract:
Aim: The aim of this thesis was to understand the literature on rib fractures, investigate the pattern of injury, management and outcomes of pateints with rib fractures at Northland District Health Board (NDHB) and across New Zealand (NZ) and create a rib fracture management guideline specific to NZ.
Methods: A literature review was performed to understand the international literature on rib fractures. A two year retrospective study was performed of patients admitted to a any hospital in NDHB with isolated blunt thoracic trauma and rib fractures. A multicentre prospective observational cohort study (RiBZ Study) was performed with the same inclusion criteria and included fourteen NZ hospitals. A qualitative study was performed to understand the barriers nurses encountered in caring for patients with rib fractures at NDHB. The RIB-IMPROVE guideline was created by incorporating local and international evidence to create a NDHB specific rib fracture guideline.
Findings: Rib fractures are common in NZ and associated with significant economic cost. The NDHB study included 170 pateints. The study found a higher than expected pneumonia rate at 18%, increased morbidity in patients 45 years and older, a low use of regional analgesia, low admission rate of high risk patients to ICU and a low utilisation of rib fixation. The qualitative study identified issues in patient care including pateints were often transferred to the ward without adequate analgesia prescribed, there was no clear referral criteria for a pain service review and that laxatives were rarely co-prescribed with analgesia. The RiBZ study included 407 pateints. The study demonstrated similar rates of pneumonia, mortality and re-presentation across NZ hospitals despite significant inter-hospital variation in patient demographics. It identified areas that are amenable to quality improvement initiatives and found a higher re-presentation rate in Māori and elderly patients.
Conclusion: This thesis defined pattern of injury, management and outcomes of pateints with rib fractures at NDHB and across NZ. An evidence based guideline was created specific to the NDHB population which was shown to be applicable to NZ. This will act as the steppingstone to improving the care of patient with rib fracture in NZ.