971: ASSOCIATION OF A RIB FRACTURE PROTOCOL WITH DECREASED NEED FOR MECHANICAL VENTILATION

Introduction: Rib fractures are the most common traumatic thoracic injury and are a major contributor to overall morbidity and mortality, particularly among geriatric patients. Triage pathways have been proposed to standardize patient care and guide clinical decisions, though compliance is low. In this single institution quality improvement project, we implemented a bundled protocol of interventions for patients with one or more rib fractures and assessed its association with patient outcomes.Methods: The protocol, introduced in 2022, included early admission directly to the intensive care unit(ICU), utilization of the Pain/Inspiration/Cough(PIC) score, multimodal pain control, early mobilization and utilization of high flow nasal cannula. We analyzed data from 2019-2025 among 657 patients with rib fractures admitted to the ICU. Risk-adjusted outcomes (ICU mortality, ICU length of stay [LOS] and need for mechanical ventilation [MV]) were compared pre- and post-implementation using a multivariable logistical regression. We also conducted a stratified analysis among patients > 65 years.Results: Patients admitted post-implementation (n=442) were more likely to be older (mean age: 63.2vs53.1), had a lower case-mix index (mean: 4.7vs8.5), and carried a higher burden of comorbidity (mean Van Walraven score: 2.4vs1.7). After risk adjustment, ICU patients >65 post-implementation had trends toward lower rates of mortality (1.9%vs4.4%, odds ratio[OR]: 0.55, 95% confidence interval [CI]: 0.19 to 2.54), shorter LOS (5.7vs7.0 days, OR: 0.02, 95% CI: -0.05 to 0.08), and lower rates of MV (11.5%vs27.5%, OR: 0.51, 95% CI: 0.22 to 1.14). The number needed to prevent respiratory deterioration was six patients. These trends were consistent when looking at the entire population of rib fracture patients admitted to the ICU.Conclusions: The implementation of a rib fracture bundle was associated with lower rates of respiratory deterioration, and trends toward lower mortality and ICU length of stay. While this could reflect over-triaging patients to the ICU, the prevention of respiratory deterioration may warrant the extra resources. Efforts to support adherence to protocolized evaluation and treatment bundles for patients with rib fractures are aligned with national attempts to improve clinical outcomes.