Understanding and Treating Rib Fractures

October 4, 2020

Albert Einstein once said, “The more I learn, the more I realize how much I don't know.”

That quote could be a keynote for General Surgery Resident Dr. Jeff Choi’s professional development time.

It all started with rib fractures. In an effort to find new non-opioid adjuncts in pain control, Stanford Health Care implemented a protocol using intravenous lidocaine (IVL) in 2012.

“If we’re doing something, I’m asking myself ‘why do we do it?” said Choi. “I want to chase the evidence and make sure we’re providing research-based care to all of the patients we look after.”

Over the last decade there’s been increasing interest in rib fractures not only because of the hospital complications they can cause but also in terms of poor quality of life due to pain control. IVL has been shown to effective in the perioperative period in various surgeries, particularly during the postoperative period.

Choi’s study, however, which was recently published in PLoS One, found that IVL was only “crudely associated” with decreased opioid requirements in the last 24 hours of admission (the time period associated with opioid use at 90 days post-discharge). No significant beneficial effects were observed When patents were stratified by age groups (< or ≥65 years). And Choi thinks that’s “totally okay.”

“We didn’t find convincing evidence that IVL is associated with decreased pain or inpatient opioid requirements, but we also didn’t see any major side effects and it didn’t lead to any negative results,” said Choi. “Scientifically, we get excited about studies with incredibly positive results, but even if you have what others may consider an insignificant finding, publishing these results allows others to see what we have done and wonder: ‘is this a true negative finding, or would results be different in other settings? Are there other scientific implications from this study?’”

Currently, rib fractures are not specifically defined in the electronic medical record, and CTs must be read by-hand to identify the type of fracture. This means it’s difficult and time consuming to mine information from larger databases. But what if he could train a computer to read the CTs for him?

“[During PD] you have time to explore the entire university. I just wanted to absorb all the exciting research that’s happening, so I went to talks at other departments and met people and built relationships all over campus,” said Choi.

One of those talks was at the Center for Artificial Intelligence in Medicine and Imaging. Now Choi is getting ready to pursue a master’s in biomedical informatics (once he finishes his current master’s in epidemiology) and learn how to apply computer vision to trauma surgery.

“My PD experience has not only impacted how I want to spend my clinical time, but I also have a clear idea about the next 10-15 years of my career,” said Choi. He says his PD time has also taught him the incalculable value of teamwork.

Choi has taken an active role in the group Surgeons Writing About Trauma (SWAT) and says he considers himself the “Chief Development Officer,” making sure his mentees achieve their goals.

“I have the opportunity to wake up every day excited to pursue research I do, only because of unwavering support of mentors past and present. I think passing such support forward is a duty and am grateful to be surrounded by others with the same mindset in SWAT,” said Choi. “Me getting involved in chest wall injury research to now—everything has been serendipitous. The faculty mentorship has really been out of this world They show me the type of leader I want to be.”