{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T05:38:42Z","timestamp":1792820322158,"version":"4.5.0"},"reference-count":14,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"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":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Traditional intensive care unit (ICU) triage criteria for older trauma patients with rib fractures emphasize age and rib fracture count but do not account for physiologic vulnerability, pre-injury frailty, and comorbid burden. We aimed to develop a risk score incorporating these variables to identify ICU-level respiratory complications in older adults with rib fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the 2022 American College of Surgeons Trauma Quality Improvement Program (TQIP) dataset. Patients aged 65-89\u00a0years with blunt trauma and ICD-10-identified rib fractures were included after exclusion of patients with major physiologic instability or confounding injuries. The primary outcome was a composite of unplanned ICU admission, unplanned intubation, acute respiratory distress syndrome, or mechanical ventilation. Multivariable logistic regression was used to derive a risk score based on frailty, comorbid conditions, and physiologic variables, with discrimination assessed using the area under the receiver operating characteristic curve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final analytic cohort included 35\u2009341 patients, among whom ICU-level respiratory complications occurred in 1523 (4.3%). A rib fracture-only model demonstrated poor discrimination (AUROC 0.51), while a model based on frailty, comorbid conditions and physiologic variables showed improved discriminatory performance (AUROC 0.66). Complication rates increased stepwise across FRAIL-ICU score categories, from 2.3% in low-risk patients to 9.5% in high-risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The FRAIL-ICU score outperforms rib fracture count alone in predicting ICU-level respiratory complications and provides meaningful risk stratification that may assist in risk stratification to inform ICU triage decisions beyond traditional age- and injury-based criteria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261450565","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T10:15:43Z","timestamp":1779444943000},"page":"2927-2933","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Frailty, Comorbid Burden, and Physiologic Factors Associated With Intensive Care Unit\u2013Level Respiratory Complications in Older Adults With Rib Fractures: A Retrospective Trauma Quality Improvement Program Study"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6799-9942","authenticated-orcid":false,"given":"Louis Miguel","family":"Prado","sequence":"first","affiliation":[{"name":"Huntington Memorial Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Vasak","sequence":"additional","affiliation":[{"name":"Huntington Memorial Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200006000-00007"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001301"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S365968"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000867"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003535"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182a833ac"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181b45598"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318270191f"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.07.098"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002891"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2004.52223.x"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200209000-00001"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2021.07.034"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2020-000639"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261450565","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348261450565","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261450565","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T05:10:07Z","timestamp":1792818607000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348261450565"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":14,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1177\/00031348261450565"],"URL":"https:\/\/doi.org\/10.1177\/00031348261450565","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]}}}