Closer to home: Managing more than three rib fractures at level IV trauma centers

INTRODUCTION Rib fractures remain a significant source of trauma admissions. In 2020, the Pennsylvania Trauma System Foundation standards changed to allow patients with more than three rib fractures to be admitted to level IV centers. The primary aim of this study was to evaluate outcomes of patients with more than three uncomplicated rib fractures admitted to level IV trauma centers. METHODS Our network database was queried for patients with isolated uncomplicated rib fractures between 2018 and 2022. Patients were stratified based on evaluation before or after the change in standards. Patients evaluated at level IV centers were compared for demographics, injury characteristics, transfer rate, and outcomes. Finally, 1:1 propensity score matching was used to create a matched group of patients with more than three rib fractures to assess outcomes based on admission to level IV versus level I/II centers. RESULTS A total of 1,070 patients with isolated rib fractures were admitted over the study period. Level IV centers evaluated 360 patients with 132 (36.6%) and 228 (63.3%) in the pre- and poststandard change periods. There was a significant reduction in transfers for isolated rib fractures (56% vs. 21% p < 0.01). Compared with patients with three or less rib fractures, those with more than three fractures had similar hospital length of stay (median [interquartile range (IQR)], 3 [2–5] vs. 2 [1–4]; p = 0.29) and mortality (0% vs. 2.3%, p = 0.22). After propensity match, there was no difference in age (median [IQR], 71 [60–81] vs. 73 [65–85]; p = 0.24), injury characteristics, hospital length of stay (median [IQR], 2.5 [2–5] vs. 2 [1–4]; p = 0.37), and mortality (1.7% vs. 0%, p = 0.30). CONCLUSION Change in state admission standards allowed for a reduction in transfer of patients with more than three isolated rib fractures. In a group of matched patients with more than three rib fractures, level IV centers had similar outcomes to level I or II centers. LEVEL OF EVIDENCE Clinical Research, Retrospective Study; Level III.