Quantifying the Effect of the Rib Injury Guideline (RIG) Score Implementation at a Level I Trauma Center on Safety...

BackgroundRib fractures in elderly trauma patients carry increased morbidity and mortality. Prior guidelines recommended indiscriminate intensive care unit (ICU) admission for patients ≥65 years with ≥3 rib fractures. In 2024, our institution implemented the Rib Injury Guideline (RIG) score, a novel triage and disposition tool, through a standardized smartphrase (SP).MethodsWe retrospectively reviewed trauma patients ≥65 years with ≥1 rib fracture admitted between 1/1/2020 and 7/5/2025. Patients admitted before 10/31/2024 (pre-RIG) were compared to those admitted after (post-RIG). Primary outcomes were ICU admission and unanticipated ICU upgrade. Secondary outcomes included mortality, ICU and hospital length of stay (LOS), and compliance with the RIG SP.Results546 patients were included, with a median age of 80 years and median Injury Severity Score (ISS) of 10. There were 462 (85%) patients pre- and 84 (15%) post-RIG. ICU utilization significantly decreased in the post-RIG cohort (61% vs 37%, OR 0.38, P < 0.01), with an even greater reduction among patients with multiple rib fractures (67% vs 38%, OR 0.29, P < 0.01). Unanticipated ICU upgrade was 1% for both groups (P > 0.99). ICU LOS (median 2 vs 3, P = 0.17), hospital LOS (median 6 vs 6, P = 0.65), and mortality (4% vs 5%, P = 0.55) were similar between cohorts. Compliance with the SP was 82%.DiscussionImplementation of the RIG score with an integrated smartphrase substantially reduced ICU admissions in elderly rib fracture patients without compromising patient safety, as evidenced by the absence of increased rates of ICU upgrades and no impact on mortality.