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Use Of Forced Vital Capacity To Triage Adolescents With Rib Fractures
*Patrick C Bonasso, Rachel L Warner, Richard A Vaughan, James M Bardes, Daniel J Grabo, Alison M Wilson
West Virginia University, Morgantown, WV

Background (issue):The purpose was to evaluate a rib fracture protocol based on the Forced Vital Capacity (FVC) to appropriately triage adolescents with rib fractures.
Methods:A 10 year retrospective analysis was performed of adolescents aged 14 to 18 years with rib fractures. Adolescents with traumatic brain injury, spinal cord injury, or intubated were excluded. All patients had an ED FVC greater than 1 and were triaged to the floor or stepdown unit. Group A (n=9) had a FVC decline <1 during hospitalization and Group B (n=59) did not have decline FVC < 1 during hospitalization. Statistical comparisons were made using T-tests for continuous variables and Fisher's exact tests for categorical variables.
Findings:Sixty-eight patients met the inclusion criteria: 9 in Group A and 59 in Group B. Group A adolescents had a higher mean number of rib fractures (p=0.043). Group A had a statistically lower mean ED FVC, high FVC during hospitalization, and low FVC during hospitalization compared to Group B. Group A adolescents had a higher Injury Severity Score (ISS) (p=0.014) and a 2.5 day longer length of stay (p=0.049) compared to Group B.
Conclusions (implications for practice):Adolescents with FVC less than 1 during admission had longer length of stay, lower average FVC during hospitalization, and higher ISS score. A rib fracture protocol with triage FVC and multimodal therapy can effectively be implemented in adolescent patients.

Group A (n=9)Group B (n=59)p-value
No. of Rib Fractures [mean (+SD)]3.4 (+ 1.3)2.2 (+ 1.6)0.043*
FVC [mean (+SD)] Admission High Low1.3 (+ 0.5) 1.6 (+ 0.5) 0.8 (+ 0.2)2.0 (+ 0.6) 2.3 (+ 0.6) 1.7 (+ 0.6)0.006* 0.0003* 0.00001*
ISS (range) (+ SD)19.9 (r: 9-30)13.2 (r:2-36)0.014*
Hospital LOS (days)*

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