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

Abstract

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. 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. 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. 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. Therapeutic/Care Management; Level III.