Bottom Line

The use of spirometry as a simple prognostic tool for older patients with multiple rib fractures is interesting. However, there is not enough high-quality evidence for it to guide us in discharging patients home from the emergency department at this time.

Case Resolution

You perform a spirometry, and the patient’s FEV1 is 64 percent of predicted. This provides a baseline but does not affect your decision to admit him to hospital on a monitored bed with the hope that he can be discharged home within the next 24 to 48 hours.

Thank you to Dr. Emil Iversen, an emergency medicine resident at the University Hospital of Zealand and vice-chair of the Danish Society for Emergency Medicine, for his help with this review.

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.

References

1. Brasel JK, Moore EE, Albrecht RA, et al. Western trauma association critical decisions in trauma: management of rib fractures. J Trauma Acute Care Surg. 2017;82(1):200-203.
2. Sadler CA, Burgess JR, Dougherty KE, et al. Bedside incentive spirometry predicts risk of pulmonary complication in patients with rib fractures. Am Surg. 2019;85(9):1051-1055.
3. Butts CA, Brady JJ, Wilhelm S, et al. Do simple bedside lung function tests predict morbidity after rib fractures? Am J Surg. 2017;213(3):473-477.
4. Cook AC, Joseph B, Inaba K, et al. Multicenter external validation of the Geriatric Trauma Outcome Score: a study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly (PALLIATE) consortium. J Trauma Acute Care Surg. 2016;80(2):204-209.
5. Hoenig JM, Heisey DM. The abuse of power: the pervasive fallacy of power calculations for data analysis. Am Stat. 2001;55(1):19-24.
6. Althouse AD. Post hoc power: not empowering, just misleading. J Surg Res. 2021;259:A3-A6.
7. Dziak JJ, Dierker LC, Abar B. The interpretation of statistical power after the data have been gathered. Curr Psychol. 2020;39(3):870-877.
8. Livingston DH, Shogan B, John P, et al. CT diagnosis of rib fractures and the prediction of acute respiratory failure. J Trauma. 2008;64(4):905-911.