Use of an Integrated Pulmonary Index pathway decreased unplanned ICU admissions in elderly patients with rib fractures

Unplanned intensive care unit (ICU) admission (UIA) is a Trauma Quality Improvement Program benchmark that is associated with increased morbidity, mortality, and length of stay (LOS). Elderly patients with multiple rib fractures are at increased risk of respiratory failure. The Integrated Pulmonary Index (IPI) assesses respiratory compromise by incorporating SpO2, respiratory rate, pulse, and end-tidal CO2 to yield an integer between 1 and 10 (worst and best). We hypothesized that IPI monitoring would decrease UIA for respiratory failure in elderly trauma patients with rib fractures. Methods Elderly (>= 65 years old) trauma inpatients admitted to a level 1 trauma center from February 2020 to February 2023 were retrospectively studied during the introduction of IPI monitoring on the trauma floor. Patients with >= 4 rib fractures (or >= 2 with history of chronic obstructive pulmonary disease) were eligible for IPI monitoring and were compared with a group of chest Abbreviated Injury Scale score of 3 (>= 3 rib fractures) patients who received usual care. Nurses contacted the surgeon for IPI <= 7. Patient intervention was left to the discretion of the provider. The primary endpoint was UIA for respiratory failure. Secondary endpoints were overall UIA, mortality, and LOS. Statistical analysis was performed using chi 2 test and Student's t-test, with p<0.05 considered significant. Results A total of 110 patients received IPI monitoring and were compared with 207 patients who did not. The IPI cohort was comparable to the non-IPI cohort in terms of gender, Injury Severity Score, Abbreviated Injury Scale, mortality, and LOS. There were 16 UIAs in the non-IPI cohort and two in the IPI cohort (p=0.039). There were no UIAs for respiratory failure in the IPI group compared with nine in the non-IPI group (p=0.03). Conclusion IPI monitoring is an easy-to-set up tool with minimal risk and was associated with a significant decrease in UIA in elderly patients with rib fracture.