Rib Fracture Protocol Improves Survival in Older Adults Without Prolonging Hospital Length of Stay

Tuesday, March 24, 2026

10:00 AM - 11:00 AM Central Time

Location: Connections Central - RST 11

Michael Clark, MD, PhD

Disclosure(s): No relevant financial relationship(s) to disclose.
KH

Krista Haines, DO

Duke University, North Carolina

Disclosure information not submitted.
PG

Patrick Georgoff, MD

Assistant Professor of Surgery
Duke University

Disclosure information not submitted.
CV

Cory Vatsaas, MD, FACS

Assistant Professor of Surgery
Duke University

Disclosure information not submitted.
Yuqi Zhang, MD, MHS

North Carolina

Disclosure(s): No relevant financial relationship(s) to disclose.
Patrycja Popowicz, MD, MS

Duke University

Disclosure(s): No relevant financial relationship(s) to disclose.
SA

Suresh Agarwal, MD, FCCM

Professor of Surgery
Duke University

Disclosure information not submitted.
JF

Joseph Fernandez-Moure, MD

Associate Professor of Surgery
Duke University

Disclosure information not submitted.

Introduction: Rib fractures are a common injury in older trauma patients and are associated with high morbidity and mortality. In March 2022, our institution implemented a standardized rib fracture protocol emphasizing early ICU triage, multimodal analgesia, and risk-stratified clinical pathways. We evaluated the protocol’s association with hospital length of stay (LOS), ICU utilization, and in-hospital mortality.

Methods: We conducted a retrospective cohort study of adult trauma patients admitted with rib fractures from 2016 to 2024. The exposure of interest was treatment under the standardized rib fracture protocol. Outcomes included LOS, ICU admission, and in-hospital mortality. LOS was modeled using gamma regression; ICU admission and mortality were modeled using multivariable logistic regression. Patients who died during hospitalization or were discharged on hospital day 0 were excluded from LOS analyses. Subgroup analyses were performed for patients aged ≥65 years. All models were adjusted for age and Injury Severity Score.

Results: Among 3,376 patients (median age 58 years, IQR 42–71; 34% women; 97% blunt injury), protocol implementation did not prolong LOS among survivors (p = 0.24), including those aged ≥65 years (p = 0.062). ICU admissions increased in the full cohort (OR = 2.38, p < 0.001) and in patients ≥65 years (OR = 3.30, p < 0.001). In the overall cohort, no mortality difference was observed (p = 0.083). However, in patients aged ≥65 years (n = 1,276, 73 deaths), protocol implementation was associated with a significantly lower odds of in-hospital mortality (OR = 0.43, 95% CI: 0.24–0.75, p = 0.004).

Conclusions: A standardized rib fracture protocol was associated with increased ICU utilization but no increase in hospital LOS. Among patients aged ≥65 years, protocol care was associated with a significant reduction in in-hospital mortality. These findings support age-targeted triage and reinforce the survival benefit of aggressive, protocolized rib fracture care in older adults.