title: A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients.
abstract: BACKGROUND
  We initiated a multidisciplinary clinical pathway targeting patients greater than 45 years of age with more than 4 rib fractures. The purpose of the current study was to evaluate the effect of this pathway on infectious morbidity and mortality.
  
  
  METHODS
  This was a prospective cohort study. Data evaluated included patient demographics, injury characteristics, pain management details, lengths of stay, morbidity, and mortality. Univariate and multivariate analyses were performed using a significance level of P < .05.
  
  
  RESULTS
  When adjusting for age, injury severity score, and number of rib fractures, the clinical pathway was associated with decreased intensive care unit length of stay by 2.4 days (95% confidence interval [CI] -4.3, -0.52 days, P = .01) hospital length of stay by 3.7 days (95% CI -7.1, -0.42 days, P = .02), pneumonias (odds ratio [OR] 0.12, 95% CI 0.04 to 0.34, P < .001), and mortality (OR 0.37, 95% CI 0.13 to 1.03, P = .06).
  
  
  CONCLUSIONS
  Implementation of a rib fracture multidisciplinary clinical pathway decreased mechanical ventilator-dependent days, lengths of stay, infectious morbidity, and mortality.
authors.affiliation: Department of Surgery, The Methodist Hospital, 6550 Fannin Street, Smith Tower 1661, Houston, TX 77030, USA. srtodd@tmh.tmc.edu <srtodd@tmh.tmc.edu>
authors.forename: S Rob
authors.initials: SR
authors.lastname: Todd
authors.forename: Michael M
authors.initials: MM
authors.lastname: McNally
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Kozar
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.forename: Ernest A
authors.initials: EA
authors.lastname: Gonzalez
authors.forename: Christine S
authors.initials: CS
authors.lastname: Cocanour
authors.forename: Gary A
authors.initials: GA
authors.lastname: Vercruysse
authors.forename: Marjorie H
authors.initials: MH
authors.lastname: Lygas
authors.forename: Bobbie K
authors.initials: BK
authors.lastname: Brasseaux
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
mesh_terms: D000368:Aged; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011446:Prospective Studies; D012121:Respiration, Artificial; D012253:Rib Fractures / Q000150:complications / Q000628:therapy*