Randomised Evaluation of incentive Spirometry in OLder adults with rib fractures to preVEnt pulmonary complications: RESOLVE
Rib fractures
In open, participating centres, staff will monitor admissions to the Emergency department to screen for suitable patients. Any patients who are 65 or older with suspicion of chest wall trauma will be considered, and those who go on to have a confirmed rib fracture will be given a summary information sheet and access to a patient video. The site staff will confirm eligibility and then approach the patient for consent. In any case where the patient is without capacity to consent, a consultee or personal legal representative (PLR) will be approached. A detailed information sheet can be provided if requested and there will be an opportunity to ask questions with the site staff member. When consent is received via a signed paper form, the delegated ED staff member can access a REDCap database and add a new participant. They will need to complete the screening information, confirming eligibility, and confirm consent has been received. Before randomisation, they will need to add the minimisation factors; who consented (patient or consultee/PLR), and whether the patient has isolated rib fractures, or rib fractures plus other injuries. The details in REDCap will then be transmitted to Sealed Envelope and a randomisation allocation will be returned. If usual care without the use of an incentive spirometer is returned, then the patient will be informed and treated according to usual care. This will include treatment for their injuries and any breathing instructions given as part of standard care. If usual care plus use of an incentive spirometer is returned, they will be informed, and an initial face-to-face training session on use of the device will be delivered by the trained site staff. If the patient is deemed to be able to use the device independently (or in the case of patients lacking capacity, their consultee/PLR is deemed to be able to support the patient independently), they will continue to use the device, 3 times a day, for 5 days. However, the trained staff may
1. Aged >=65 years 2. Radiological evidence of acute rib fracture(s) 3. Planned for admission 4. Has capacity to provide informed consent or personal consultee/legal representative available and able to support use of incentive spirometer
1. Coexisting injury or condition for which treating clinician deems patient unable to use incentive spirometer (e.g. facial injuries; burns to both hands; advanced dementia) 2. Patients who have Sp02 <92% on air at time of screening (< 88% for known chronic lung disease) 3. Intubated 4. Haemodynamic instability (e.g severe hypo- or hypertension, significant atrial/ventricular arrhythmia) 5. History of eye, inner ear or brain surgery within previous 4 weeks (Contraindication to using incentive spirometry)