Risk factors and resolution of patient-reported pain and mental health symptoms following rib fracture(s)

Madison Sundlof; Kayla Switalla; Emma K Jones; Matthew Bahr; Michael Doering; David Martin; John McCormick-Deaton; Genevieve B Melton-Meaux; Christopher J Tignanelli

doi:10.1097/TA.0000000000004529

Risk factors and resolution of patient-reported pain and mental health symptoms following rib fracture(s)

J Trauma Acute Care Surg. 2025 Jan 6. doi: 10.1097/TA.0000000000004529. Online ahead of print.

Authors

Madison Sundlof¹, Kayla Switalla, Emma K Jones, Matthew Bahr, Michael Doering, David Martin, John McCormick-Deaton, Genevieve B Melton-Meaux, Christopher J Tignanelli

Affiliation

¹ From the Department of Surgery, University of Minnesota Medical School (M.S., K.S.); Department of Surgery (E.K.J., D.M., J.M.-D.), University of Minnesota; Fairview Health Services, Trauma Services, (M.B., M.D.); and Department of Surgery (G.B.M.-M., C.J.T.), Institute for Health Informatics (G.B.M.-M., C.T.), and Center for Learning Health System Sciences (G.B.M.-M., C.T.), University of Minnesota, Minneapolis, Minnesota.

PMID: 39760727
DOI: 10.1097/TA.0000000000004529

Abstract

Background: Rib fractures, constituting 10% to 15% of trauma admissions, contribute significantly to morbidity and mortality. Effective postdischarge patient care remains a challenge. Our system has operationalized patient-reported outcome measures (PROMs) via a mobile platform into routine postdischarge monitoring for rib fracture patients. This study aimed to use PROMs to investigate the association between patient factors and postdischarge pain and mental health.

Methods: We collected PROMs from nine Midwest trauma hospitals (2021-2022) using a mobile platform. The platform provided automated check-ins, education, health reminders, and 24/7 monitored interventions based on PROM responses. Multivariate logistic regression was used to investigate the association of patient factors for the primary outcome. The primary outcome was pain 2 weeks postdischarge (days 4-14). Secondary outcomes were mental health at 1 week, with long-term assessments at one and 3 months.

Results: Of 72 patients, 55.6% reported moderate to severe pain at 2 weeks, with higher admission pain scores associated with increased pain (odds ratio, 1.69; 95% confidence interval, 1.15-2.5; p < 0.01). By 4 weeks, 29.4% of responding patients reported persistent moderate-to-severe pain, decreasing to 4.0% by 12 weeks. Patients with moderate-to-severe pain within the first 2 weeks also reported significantly higher rates of mental health symptoms at (44.8% vs. 16.7%) compared with mild pain. By weeks 4 and 12, mental health differences between pain groups were insignificant.

Conclusion: This study suggests a potential link between early pain and mental health symptoms. In addition, higher pain at admission may predict worse pain outcomes 2 weeks postdischarge. Patients in our cohort showed improvement in both pain and mental health symptoms within 4 to 12 weeks. These findings highlight the opportunity for PROMs and mobile apps to support optimal postdischarge follow-up and help minimize persistent pain, particularly for rib fracture patients with identifiable risk factors.

Level of evidence: Therapeutic/Care Management; Level IV.