Background: Painful inspiration due to rib fractures impairs one’s ability to cough and deep-breathe thus diminishing their ability to clear respiratory secretions and debris resulting in the development of pneumonia and atelectasis. Pneumonia remains a common complication of rib fractures in those aged 65 and older with a 22% mortality rate. This study aims to define the risk factors, onset, and duration of pulmonary decline in trauma patients with isolated rib fractures.

Methods: This was a single center retrospective research study done at a Level I tertiary care Trauma center. The study had 483 patients aged 18 and older who sustained rib fractures between January 2017 and September 2022. 171 (35.4%) were escalated to a critical care unit; intensive care unit (ICU) or Step-down-unit, while the remaining 312 (64.6%) did not. Descriptive statistics were presented in the form of median and interquartile range (BMI) or frequencies and percentages (all other variables). Unadjusted associations between each potential predictor and service escalation were assessed using the Wilcoxon-Mann-Whitney test (BMI) and chi-square tests. A logistic regression was fit with service escalation as the dependent variable and nearly all the demographics, comorbidities, and medications as independent variables.

Results: A history of chronic obstructive pulmonary disease was more common in the escalated group 21.1% (n = 36), versus in the non-escalated group 12.8% (n = 40) at p = 0.025. Also, 25.7% (n = 44) of those in the escalated group were taking an anticoagulant, compared to 14.7% (n = 46) of those in the non-escalated group (p = 0.004). Most (90.1%, n = 154) were transferred to the ICU within the first 20 hours. An additional 4.1% (n = 7) were transferred within the first 30 hours, while less than 6% (n = 10) took longer to be transferred. Having an incentive spirometry above 1,000 significantly reduced the odds of escalation by nearly 95%, OR = 0.054 0.029, 0.097, p < 0.001. Having a history of chronic obstructive pulmonary disease more than doubled the odds of transfer to the intensive care unit, OR = 2.447 1.286, 4.688, p = 0.007.

Conclusion: Pulmonary decline following rib fractures can last for 20 to 36 hours after injury, for which the biggest risk factors are an admission incentive spirometry of less than 1,000 mL and a history of chronic obstructive pulmonary disease.