Magnitude of rib fracture displacement predicts opioid requirements.

Introduction: It is unknown whether the magnitude of rib fracture (RF) displacement predicts pain medication requirements in blunt chest trauma patients. Methods: Adult blunt RF patients undergoing chest computed tomography (CT) admitted to an urban Level 1 trauma center (2007-2012) were retrospectively reviewed. Pain management in those with displaced RF (DRF), non-displaced RF (NDRF), or combined DRF and NDRF (CRF) was compared by univariate analysis. Linear regression models were developed to determine whether total opioids requirements [expressed as log morphine equianalgesic dose (MED)] could be predicted by the magnitude of RF displacement (expressed as the sum of the Euclidean distance of all displaced RF) or number of RF, after adjusting for patient and injury characteristics. Results: There were 245 patients, of whom 39 (16%) had DRF only, 77 (31%) had NDRF only, and 129 (53%) had CRF. Opioids were given to 224 (91%) patients. Compared to DRF (mean1.7 RF/patient) and NDRF patients (2.4 RF/patient), those with CRF (6.8 RF/patient) were older and had more RF per patient and a higher ISS and MED (251 vs. 53 and 105 mg, respectively, p

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