The Impact of Delayed Intubation on Outcomes and Resource Utilization of Patients Sustaining Multiple Rib Fractures

Authors

Junsik Kwon, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA, USA.
Bishoy Zakhary, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA, USA.
Navpreet Dhillon, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA, USA.
Bruno C. Coimbra, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Babak Sarani, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Raul Coimbra, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA, USA.

Document Type

Journal Article

Publication Date

6-15-2025

Journal

The American surgeon

DOI

10.1177/00031348251351008

Keywords

complications; flail chest; intubation; mortality; rib fractures

Abstract

BackgroundPatients with multiple rib fractures may require mechanical ventilation due to respiratory insufficiency. We hypothesized that delayed intubation leads to worse outcomes compared to early intubation.MethodsWe analyzed data from the Trauma Quality Improvement Program database (2017-2021) for adults with ≥ 3 rib fractures requiring intubation. Patients were divided into groups of early and delayed intubation (after 24 hours from admission). Outcomes included in-hospital mortality, complications, and tracheostomy need. Resource utilization metrics were compared. Groups were balanced using inverse probability of treatment weighting, and complex samples logistic regression was used to evaluate the effect of delayed intubation on outcomes while controlling for covariates.ResultsOut of 191,816 patients with ≥3 rib fractures, 5339 underwent early intubation and 4004 underwent delayed intubation. Delayed intubation patients were older, more often female, less severely injured, had fewer bilateral fractures and flail chest, but higher tracheostomy need. Factors associated with delayed intubation included age > 60, ISS < 16, absence of bilateral fractures, smoking, and COPD. After adjustment, delayed intubation was associated with higher mortality (19.7% vs 13.7%), longer hospital and ICU stays, increased mechanical ventilation duration, and fewer ICU- and ventilator-free days. Additionally, delayed intubation was linked to increased ARDS, pulmonary embolism, severe sepsis, and acute kidney injury. It independently increased mortality odds (OR 1.584).DiscussionDelayed intubation in patients with multiple rib fractures is associated with worse clinical outcomes and increased resource utilization. This link between delayed intubation and worse outcomes highlights the importance of recognizing at-risk individuals and considering early intubation.

APA Citation

Kwon, Junsik; Zakhary, Bishoy; Dhillon, Navpreet; Coimbra, Bruno C.; Sarani, Babak; and Coimbra, Raul, "The Impact of Delayed Intubation on Outcomes and Resource Utilization of Patients Sustaining Multiple Rib Fractures" (2025). GW Authored Works. Paper 7413.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7413

Department

Surgery