M. E. Chang1, T. Wheeler1, O. Obaid1, H. Hosseinpour1, K. El-Qawaqzeh1, S. K. Bhogadi1, L. Gries1 1University of Arizona, Department Of Surgery, Tucson, AZ, USA
Introduction:
In 2020, the Rib Injury Guidelines (RIG) was instituted at our institution to help triage admission of patients with traumatic rib fractures to the floor or surgical ICU and standardize their treatment. The RIG score is a score based on patient factors and clinical findings including age, number of rib fractures, imaging characteristics, pain, history of asthma, smoking or COPD, ability to cough and inspiratory spirometry. The aim of this study was to identify predictors for longer ICU length of stay for patients with rib fractures.
Methods:
A retrospective analysis of all patients admitted to the surgical ICU from 2020 through 2022 was performed. Inclusion criteria were patient admitted to the ICU with rib fractures and a documented RIG score ≥ 10 on the initial Trauma H&P note. A RIG score of 10 is the threshold for ICU admission based on the previous work completed on the Rib Injury Guidelines. Primary outcome was ICU length of stay. Secondary outcomes were use of treatment adjuncts (rib fixation and regional anesthesia) and their correlation to ICU length of stay. Multivariable linear regression analysis was performed to identify independent predictors of longer ICU length of stay
Results:
A total of 316 patients were admitted to the ICU with rib fractures, of which 102 were admitted based on their RIG score alone. From this sample population the average ICU length of stay was four days, and patients had an average of six rib fractures. Mean age was 66. Using a multivariable linear regression analysis, predictors for an extended ICU length of stay were: intubation, greater than five rib fractures, bilateral rib fractures, severe pulmonary contusion, and RIG score, all with p values < 0.05. Age, history of COPD, and hemothorax or pneumothorax did not have a significant impact on the length of ICU stay. Secondary outcomes were underpowered and represented a very small minority of the patients in the study.
Conclusion:
In conclusion, our study showed that the RIG score is an independent predictor of ICU length of stay for patients with traumatic rib fractures. Having greater than five rib fractures and the presence of bilateral rib fractures are two independent factors that can be identified on admission as predictors of longer ICU length of stay. RIG is a safe and effective method for identifying patients with severe traumatic rib fractures and has helped to optimize our use of ICU resources for these patients.
