title: Improved Outcomes Associated with the Liberal Use of Thoracic Epidural Analgesia in Patients with Rib Fractures.
abstract: OBJECTIVE
  Each year, more than 150,000 patients with rib fractures are admitted to US trauma centers; as many as 10% die. Effective pain control is critical to survival. One way to manage pain is thoracic epidural analgesia. If this treatment reduces mortality, more frequent use may be indicated.
  
  
  METHODS
  We analyzed the patient registry of a level II trauma center. All patients admitted with one or more rib fractures (N = 1,347) were considered. Patients who were not candidates for epidural analgesia (N = 382) were eliminated. Mortality was assessed with binary logistic regressions.
  
  
  RESULTS
  Across the total population, mortality was 6.7%; incidence of pneumonia was 11.1%; mechanical ventilation was required in 23.8% of patients, for an average duration of 10.0 days; average stay in the hospital was 7.7 nights; and 49.7% of patients were admitted to the ICU for an average of 7.2 nights. Epidural analgesia was administered to 18.4% of patients. After matching samples for candidacy, patients who received epidurals were 3.7 years older, fractured 2.6 more ribs, had higher injury severity scores, and were more likely to present with bilateral fractures, flail segments, pulmonary contusions, hemothoraces, and pneumothoraces. Despite greater injury severity, mortality among these patients was lower (0.5%) than those who received alternative care (1.9%). Controlling for age, injury severity, and use of mechanical ventilation, epidural analgesia predicted a 97% reduction in mortality.
  
  
  CONCLUSIONS
  Thoracic epidural analgesia associates with reduced mortality in rib fracture patients. Better care of this population is likely to be facilitated by more frequent reliance on this treatment.
authors.affiliation: Department of Health, Exercise, and Sport Sciences, University of the Pacific, Stockton, California.
authors.forename: Courtney D
authors.initials: CD
authors.lastname: Jensen
authors.affiliation: Sum Integral, Chicago, Illinois.
authors.forename: Jamie T
authors.initials: JT
authors.lastname: Stark
authors.affiliation: St. Vincent Hospital, Indianapolis, Indiana.
authors.forename: Lewis L
authors.initials: LL
authors.lastname: Jacobson
authors.affiliation: Parkview Health, Fort Wayne, Indiana.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Powers
authors.affiliation: Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Joseph
authors.affiliation: Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Kinsella-Shaw
authors.affiliation: Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Denegar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods*; D012189:Retrospective Studies; D012253:Rib Fractures / Q000150:complications* / Q000401:mortality; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
keywords: Analgesic; Anesthesiology; Epidural; Opioids; Pain Management; Regional Pain; Thoracic; Trauma