{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:06:15Z","timestamp":1785139575348,"version":"3.55.0"},"reference-count":10,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"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"],"abstract":"<jats:p>\n                    The objective of this study was to determine whether protocolized triage using the Rib Injury Guidelines (RIG) can safely reduce intensive care unit (ICU) admissions and improve institutional resource utilization in a rural, Appalachian, level 1 trauma center. This was a single-center retrospective cohort study that included a total of 1148 adult patients who presented to the institution with radiographically confirmed rib fracture(s) over the course of 2\u00a0years (557 pre-RIG, 591 post-RIG). Prior to RIG implementation, triage decisions were made at the discretion of the attending provider using a protocol based on three factors: \u22653 rib fractures, age &gt;65, and incentive spirometry (IS) &lt;1L or &lt;15\u00a0mL\/kg ideal body weight (IBW). Patients in the post-RIG group were of higher acuity with a significantly higher percentage having \u22653 rib fractures (53.3% vs 45.2%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.006) and thoracic injuries as their highest Abbreviated Injury Scale (AIS) score (56.0% vs 24.6%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; 0.001). Despite this higher acuity, implementation of RIG was associated with a 28.9% decrease in ICU admissions from the ED (OR 0.711, 95% CI: 0.563-0.899,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.004) without a corresponding increase in floor-to-ICU transfers (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.166), unplanned intubations (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.803), morbidity, or mortality (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.364). Additionally, it reduced the hospital charges incurred by each patient. These findings suggest that protocolized triage using RIG is feasible and safe in rural settings, improving resource utilization without compromising patient outcomes.\n                  <\/jats:p>","DOI":"10.1177\/00031348261471470","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T02:27:31Z","timestamp":1784946451000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Protocolized Rib Fracture Triage Reduces ICU Admissions Without Compromising Outcomes in a Rural Level 1 Trauma Center"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3025-0189","authenticated-orcid":false,"given":"Meghan","family":"Johns","sequence":"first","affiliation":[{"name":"East Tennessee State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7409-9925","authenticated-orcid":false,"given":"Hunter","family":"Johnson","sequence":"additional","affiliation":[{"name":"East Tennessee State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caleb","family":"Zepeda","sequence":"additional","affiliation":[{"name":"East Tennessee State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7991-8227","authenticated-orcid":false,"given":"Cheyenne","family":"Fugate","sequence":"additional","affiliation":[{"name":"East Tennessee State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Smith","sequence":"additional","affiliation":[{"name":"East Tennessee State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Powell","sequence":"additional","affiliation":[{"name":"East Tennessee State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Collins","sequence":"additional","affiliation":[{"name":"Ballad Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"King","sequence":"additional","affiliation":[{"name":"Ballad Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keelin","family":"Roche","sequence":"additional","affiliation":[{"name":"Quillen College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Bracken","family":"Burns","sequence":"additional","affiliation":[{"name":"Quillen College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalli","family":"Devecki","sequence":"additional","affiliation":[{"name":"Quillen College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpsurg.2024.101663"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/000313482093907"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003535"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2020.09.062"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2021.07.022"},{"key":"e_1_3_5_7_2","volume-title":"Using Rib Injury Guidelines to Predict ICU Length of Stay for Rib Fracture Patients","author":"Chang ME","year":"2024","unstructured":"Chang ME, Wheeler T, Obaid O, et al. Using Rib Injury Guidelines to Predict ICU Length of Stay for Rib Fracture Patients. Academic Surgical Congress; 2024. Abstract presented at."},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19292"},{"key":"e_1_3_5_9_2","volume-title":"Health Disparities in Appalachia","author":"Appalachian Regional Commission","year":"2017","unstructured":"Appalachian Regional Commission. Health Disparities in Appalachia. Appalachian Regional Commission; 2017. Accessed 2026."},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003830"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2016-000064"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261471470","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348261471470","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261471470","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T07:53:53Z","timestamp":1785138833000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348261471470"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":10,"alternative-id":["10.1177\/00031348261471470"],"URL":"https:\/\/doi.org\/10.1177\/00031348261471470","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"article-number":"00031348261471470"}}