TY - JOUR
T1 - It doesn't hurt as long as i don't move
T2 - Aligning pain assessment in patients with rib fractures with mobilization needed for recovery
AU - Bauman, Zachary M.
AU - Phillips, Jakob
AU - Tian, Yuqian
AU - Cavlovic, Lindsey
AU - Raposo-Hadley, Ashley
AU - Khan, Hason
AU - Evans, Charity H.
AU - Kamien, Andrew
AU - Cemaj, Samuel
AU - Sheppard, Olabisi
AU - Lamb, Gina
AU - Veatch, Jessica
AU - Matos, Mike
AU - Cantrell, Emily
N1 - Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/12/1
Y1 - 2024/12/1
N2 - BACKGROUND: Rib fracture pain is a major issue but likely underappreciated, given that patients avoid activity due to the pain. Pain is one criterion used to determine if someone is a candidate for surgical stabilization of rib fractures (SSRF). The purpose of this study was to assess pain for rib fracture patients, hypothesizing pain from rib fractures is underappreciated in current practice. METHODS: A prospective study analyzing patients with one or more rib fractures admitted to our Level I trauma center from March 2023 through February 2024. Exclusion criteria included refusal to participate, ventilator dependent, younger than 18 years, moderate/severe traumatic brain injury, spinal cord injury, pregnancy, or incarceration. Basic demographics were obtained. Participants rated their pain on an 11-point Numerical Rating Scale while resting in bed and performing a series of movements (0, no pain; 10, worst pain imaginable). Movements included incentive spirometer, flexion, extension, bilateral side bending, bilateral rotation, and holding a 5-pound dumbbell. Patients undergoing SSRF were surveyed pre-and postoperatively. Outcomes included the difference between pain scores at rest versus performing all movements, difference between pain scores pre-and post-SSRF, and incentive spirometry pre-and postoperatively. Nonparametric analysis was completed with the Wilcoxon signed-rank test with statistical significance set at p < 0.05. RESULTS: One-hundred two patients were enrolled. The mean age was 60 ± 15 years; 57.8% were male. The median pain score at rest was 3 (interquartile range [IQR], 2-5.5). Pain scores significantly increased to >5 for all movements. Thirty-one patients underwent SSRF. Resting pain prior to SSRF was 3 (IQR, 1-6) and postoperatively was 2 (IQR, 1.5-3) (p = 0.446). For all movements, median Numerical Rating Scale score was significantly less after SSRF (p < 0.001). The median incentive spirometry was 1,100 mL (IQR, 625-1,600 mL) preoperatively and 2,000 mL (IQR, 1,475-2,250 mL) postoperatively. CONCLUSION: Traditional assessment of pain in patients with rib fractures significantly underappreciates true pain severity caused by movements involving the chest wall and should be considered when evaluating for SSRF. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level II.
AB - BACKGROUND: Rib fracture pain is a major issue but likely underappreciated, given that patients avoid activity due to the pain. Pain is one criterion used to determine if someone is a candidate for surgical stabilization of rib fractures (SSRF). The purpose of this study was to assess pain for rib fracture patients, hypothesizing pain from rib fractures is underappreciated in current practice. METHODS: A prospective study analyzing patients with one or more rib fractures admitted to our Level I trauma center from March 2023 through February 2024. Exclusion criteria included refusal to participate, ventilator dependent, younger than 18 years, moderate/severe traumatic brain injury, spinal cord injury, pregnancy, or incarceration. Basic demographics were obtained. Participants rated their pain on an 11-point Numerical Rating Scale while resting in bed and performing a series of movements (0, no pain; 10, worst pain imaginable). Movements included incentive spirometer, flexion, extension, bilateral side bending, bilateral rotation, and holding a 5-pound dumbbell. Patients undergoing SSRF were surveyed pre-and postoperatively. Outcomes included the difference between pain scores at rest versus performing all movements, difference between pain scores pre-and post-SSRF, and incentive spirometry pre-and postoperatively. Nonparametric analysis was completed with the Wilcoxon signed-rank test with statistical significance set at p < 0.05. RESULTS: One-hundred two patients were enrolled. The mean age was 60 ± 15 years; 57.8% were male. The median pain score at rest was 3 (interquartile range [IQR], 2-5.5). Pain scores significantly increased to >5 for all movements. Thirty-one patients underwent SSRF. Resting pain prior to SSRF was 3 (IQR, 1-6) and postoperatively was 2 (IQR, 1.5-3) (p = 0.446). For all movements, median Numerical Rating Scale score was significantly less after SSRF (p < 0.001). The median incentive spirometry was 1,100 mL (IQR, 625-1,600 mL) preoperatively and 2,000 mL (IQR, 1,475-2,250 mL) postoperatively. CONCLUSION: Traditional assessment of pain in patients with rib fractures significantly underappreciates true pain severity caused by movements involving the chest wall and should be considered when evaluating for SSRF. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level II.
KW - Numerical Rating Scale
KW - Rib fractures
KW - incentive spirometry
KW - pain
KW - surgical stabilization of rib fractures
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U2 - 10.1097/TA.0000000000004446
DO - 10.1097/TA.0000000000004446
M3 - Article
C2 - 39405440
AN - SCOPUS:85207630434
SN - 2163-0755
VL - 97
SP - 856
EP - 860
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 6
ER -