{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:41:05Z","timestamp":1777448465458,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2025,6,15]],"date-time":"2025-06-15T00:00:00Z","timestamp":1749945600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from the Trauma Quality Improvement Program database (2017-2021) for adults with \u2265 3 rib fractures requiring intubation. Patients were divided into groups of early and delayed intubation (after 24\u00a0hours 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 191,816 patients with \u22653 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 &gt; 60, ISS &lt; 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Delayed 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251351008","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T01:34:28Z","timestamp":1750037668000},"page":"1690-1697","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Delayed Intubation on Outcomes and Resource Utilization of Patients Sustaining Multiple Rib Fractures"],"prefix":"10.1177","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3164-4995","authenticated-orcid":false,"given":"Junsik","family":"Kwon","sequence":"first","affiliation":[{"name":"Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA, USA"},{"name":"Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3162-7389","authenticated-orcid":false,"given":"Bishoy","family":"Zakhary","sequence":"additional","affiliation":[{"name":"Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Navpreet","family":"Dhillon","sequence":"additional","affiliation":[{"name":"Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA, USA"},{"name":"Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Moreno Valley, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno C.","family":"Coimbra","sequence":"additional","affiliation":[{"name":"George Washington University School of Medicine and Health Sciences, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babak","family":"Sarani","sequence":"additional","affiliation":[{"name":"George Washington University School of Medicine and Health Sciences, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3759-6851","authenticated-orcid":false,"given":"Raul","family":"Coimbra","sequence":"additional","affiliation":[{"name":"Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA, USA"},{"name":"Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Moreno Valley, CA, USA"},{"name":"Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,6,15]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31827018a5"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(16)42291-7"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000233879.58720.87"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1205-6"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2015.12.018"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201810-2050CP"},{"issue":"1","key":"e_1_3_6_8_2","first-page":"35","article-title":"Early intubation vs. Supportive care in management of severe blunt chest trauma; a randomized trial study","volume":"7","author":"Nasr-Esfahani M","year":"2019","unstructured":"Nasr-Esfahani M, Boroumand AB, Kolahdouzan M. 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[Effect of intubation timing on the clinical course of polytrauma patients with lung contusions]. Zentralbl Chir. 1996;121(1):21-23.","journal-title":"Zentralbl Chir"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00063110-199403000-00002"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201605-1081CP"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2022.154062"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000003296"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-017-1585-z"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2011.03.044"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00041.2010"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0704(03)00098-8"},{"issue":"2","key":"e_1_3_6_19_2","first-page":"424","article-title":"Continuous thoracic paravertebral infusion of bupivacaine for pain management in patients with multiple fractured ribs","volume":"123","author":"Karmakar MK","year":"2003","unstructured":"Karmakar MK, Critchley LA, Ho AM, Gin T, Lee TW, Yim AP. 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