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Published on: November 8, 2024
Protocolized Rib Fracture Triage Reduces ICU Admissions Without Compromising Outcomes in a Rural Level 1 Trauma
Meghan Johns1, Hunter Johnson1, Caleb Zepeda1
1Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
The American Surgeon
|July 24, 2026
Summary
Protocolized triage using Rib Injury Guidelines (RIG) safely reduced intensive care unit admissions in a rural trauma center. This improved resource utilization without impacting patient outcomes, demonstrating RIG
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Health Services Research
Background:
- Rib fractures are common injuries in trauma patients.
- Current triage protocols may lead to over or under-utilization of intensive care unit (ICU) resources.
- Standardized triage guidelines are needed to optimize patient care and resource allocation.
Purpose of the Study:
- To evaluate the impact of protocolized triage using Rib Injury Guidelines (RIG) on ICU admissions and resource utilization.
- To assess the safety and feasibility of RIG implementation in a rural, level 1 trauma center.
- To determine if RIG can reduce hospital charges without compromising patient outcomes.
Main Methods:
- Retrospective cohort study of 1148 adult patients with rib fractures over 2 years.
- Comparison of pre-RIG (provider discretion) and post-RIG (protocolized triage) implementation periods.
- Analysis of ICU admissions, floor-to-ICU transfers, unplanned intubations, morbidity, mortality, and hospital charges.
Main Results:
- The post-RIG group had higher acuity patients (more rib fractures, higher AIS scores).
- RIG implementation was associated with a 28.9% decrease in ICU admissions from the ED (P=0.004).
- No significant increase in floor-to-ICU transfers, unplanned intubations, morbidity, or mortality was observed. Hospital charges were reduced.
Conclusions:
- Protocolized triage using RIG is safe and feasible in rural trauma settings.
- RIG effectively reduces ICU admissions and improves resource utilization.
- Implementation of RIG optimizes care for rib fracture patients without adverse effects on outcomes.
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