Objectives: Rib fractures are often reported to be the cause of high morbidity and mortality in trauma patients. The goal of this study was to determine if a modified PIC score (Pain, incentive spirometry, cough) could be used to triage patients with isolated rib fractures to the ICU.
Methods: This is a single institution retrospective study reviewing all adult patients at a level one trauma center from January 2019 to August 2020 using a trauma data base. Exclusion criteria included patients with an abbreviated injury scale of over 2 in any other body system except the chest or patients who were intubated in the trauma bay or field. We collected demographic data, mechanism of injury, comorbidities, PIC scores, Injury Severity Score (ISS), morphine milligram equivalents (MME) of narcotics given, and outcome data.
Results: A total of 262 patients were included in the study. The mean age was 57.4 years with 66.8% (175) male. Mechanical fall was the most common mechanism of injury (n=108). Patients’ mean ISS score was 12.2. The patients’ mortality rate was 1.1% and the need for ventilator was 2.7%. While patients with lower PIC scores were more likely to have longer ICU LOS (p <.001), PIC scores were not statistically correlated with mortality (p=0.593), need for upgrade care (p=0.213), or need for ventilator care (p=0.631). Patients admitted to the ICU had higher narcotic usage (70.1 vs 56.8 MME, p=.034).
Conclusion: This study suggests PIC score is a poor predictor of patients requiring ICU care and leads to increased ICU utilization.
