Has the Implementation of the ‘COMBAT’ Package of Care for Chest Trauma Patients Improved Morbidity and Mortality?
Brand, M., Department of General Surgery, CMH, Auckland, New Zealand Wijayanayaka, D., Department of General Surgery, CMH, Auckland, New Zealand Henshall, K., Trauma Service, General Surgery, CMH, Auckland, New Zealand MacCormick, A.D., Department of Surgery, University of Auckland, Auckland, NZ & Department of General Surgery, CMH, Auckland, New Zealand
Introduction: Rib fractures are a common clinically significant injury and are associated with significant morbidity and mortality, largely due to lower respiratory tract infections (LRTI). The ‘COMBAT’ package of care was developed at Counties Manukau Health (CMH), in 2018, to ensure patients receive proactive, comprehensive and consistent management of blunt chest trauma. 'COMBAT' stands for: Critical Care review; Oxygen therapy; Mobilise; Breathing exercises; Analgesia/Acute Pain Service referral; Timely referral to physiotherapy.
Aims: To compare morbidity and mortality in patients with rib fractures following blunt chest trauma before and after the implementation of the ‘COMBAT’ package of care.
Methods: We performed a retrospective analysis of all patients admitted under General Surgery at Middlemore Hospital with rib fractures over three separate six month periods (one pre-intervention and two post-intervention). We included adult patients with clinical or radiological rib fractures following blunt chest trauma. Lower respiratory tract infection was the primary measure of morbidity.
Results: 254 patients were included in the study (85 in 2017; 82 in 2019; 85 in 2020). LRTIs occurred in 28% patients pre-intervention and dropped to 14% post-intervention (p = 0.01). Mean length of stay decreased post-intervention, from 8.1 to 6 days (p = 0.01). There was also a trend towards reduced mean length of stay in critical care.
Conclusion: Since the implementation of ‘COMBAT’, the rate of LRTI in patients with injuries following blunt chest trauma has halved and mean length of stay reduced by nearly 2 days.
- Martin TJ, Eltorai AS, Dunn R, Varone A, Joyce MF, Kheirbek T, et al. Clinical management of rib fractures and methods for prevention of pulmonary complications: A review. Injury. 2019;50(6):1159-65.
- Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017;2(1):1–7.