Audit of epidural use in patients attending with rib fractures at the Royal Derby Hospital

Abstract

Aims: Chest trauma leading to rib fractures is a well-known cause of significant morbidity and mortality, often from respiratory complications. Patients over the age of 65 with multiple fractures are at higher risk for such complications and early effective analgesia is known to reduce this risk. Our retrospective audit of the management of patients with rib fractures presenting to our hospital reviewed the use of epidural analgesia and the association with mortality. Method: We reviewed the notes and imaging of 109 patients who had been admitted to the Royal Derby Hospital within a one-year period with a diagnosis of rib fracture. Rate of epidural use and mortality was calculated using three age groups (>45; 45-65; >65) and according to the number of ribs fractured (RFx) (>3 RFx; 3-5 RFx; >5 RFx). Results: The overall rate of epidural analgesia was 20% (22 patients). The rate of epidural use increased with increasing number of rib fractures (>3 RFx 7%; 3-5 RFx 23%; >5 RFx 67%). Epidural use also differed between age groups (>45 18%; 45-65 40%; >65 14%). Mortality increased with age of the patient (>45 0%; 45-65 4%; >65 11%) but not with the number of rib fractures (>3 RFx 9.3%; 3-5 RFx 5.0%; >5 RFx 0%). Conclusion: Results suggest that whilst the elderly have the highest mortality associated with rib fractures, the use of epidural analgesia is underutilised in this group, especially in those who have 5 or fewer rib fractures. In the groups where rate of epidural use is high, mortality is low.