EP 400 Optimising Haemostasis of Patients with Rib Fractures

Aim

Optimising haemostasis of patients with rib fractures at a district general hospital.

Methodology

This retrospective quality improvement project included patients admitted with rib fractures under the general surgical team over a six-month period (01/01/2025–01/07/2025). Data was collected from the electronic health record (Cerner) and outcomes were analysed. Data will be presented as median (range). Statistical analysis conducted on GraphPad Prism.

Results

111 patients were included, age of 74 (26–100) years. Fifty-two patients (46%) had a Clinical Frailty Score (CFS) >=4. Twenty-six (23.4%) patients had a battle score >25. Four patients died as a sequela of these injuries. The deceased patients were 88 (84-92) years old, with a battle score of 30 (25-34) and a CFS of 4.

Seventeen patients were on anticoagulation, predominantly on direct oral anticoagulants (n=15). Twelve patients were anticoagulated for atrial fibrillation, four for venous thromboembolism and one for a metallic heart valve. Six patients were discussed with haematology, management strategies were inconsistent, with only two patients receiving reversal agents.

The average length of stay (LOS) of patients on anticoagulation was 16 (3-90) days versus 8 (1-40) days in the non-anticoagulated group (p= 0.062). Tranexamic acid was administered to eight patients; none were on antiplatelets. Four patients required blood transfusion, none related to rib fractures. Bleeding complications were uncommon.

Conclusion

Frail patients with complex co-morbidities including those on anticoagulation experienced longer LOS and inconsistent haemostasis. Establishing a ‘Rib fracture pathway’ will optimise patient care. LOS was not statistically significant, as likely underpowered.