---
title: "Unplanned ICU Transfer After Severe Rib Fracture Raises Mortality and Respiratory Complication Risk"
id: "pubmed-42929076"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42929076"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42929076/"
doi: "10.1177/00031348261499205"
published_at: "2026-10-26T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Unplanned ICU Transfer After Severe Rib Fracture Raises Mortality and Respiratory Complication Risk
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42929076
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42929076/)
- **DOI:** [10.1177/00031348261499205](https://doi.org/10.1177%2F00031348261499205)
- **Published At:** 2026-10-26T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The authors analyzed adult blunt-trauma patients with isolated severe thoracic injury and one or more **rib fractures** in the ACS Trauma Quality Improvement Program (TQIP) from 2013–2021. - Patients were separated by initial disposition: direct **ICU** admission versus initial ward placement with subsequent unplanned ICU transfer. - Among 52,332 patients admitted to the ICU, 1,830 (3.5%) underwent an unplanned ICU transfer from the ward. - Multivariable Poisson regression with robust standard errors adjusted for confounding; the source reported adjusted relative risks (RR) for key outcomes. - Unplanned transfer carried higher adjusted risk of in-hospital **mortality** (RR 3.35, 95% CI 2.89–3.88). - Respiratory complications increased with unplanned transfer: **pneumonia** (RR 2.68, 95% CI 2.08–3.45) and **ARDS** (RR 4.52, 95% CI 3.42–5.97). - Need for mechanical ventilation was also more frequent after unplanned transfer (RR 3.21, 95% CI 2.98–3.47). - Investigators concluded that unplanned ICU admission independently associates with markedly worse outcomes and suggested that improved early risk stratification might reduce delayed recognition and ward failure. - The abstract did not report which specific risk-stratification tools, clinical thresholds, or timing criteria were used to guide admission decisions. - The study used a retrospective registry design (ACS-TQIP); the source did not detail center-level triage policies, physiologic triggers, or granular timing of deterioration prior to transfer.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Ward Failure After Severe Rib Fracture: What Unplanned ICU Transfer Teaches Us About Early Risk Stratification [Yousef AlHussaini](https://pubmed.ncbi.nlm.nih.gov/?term=AlHussaini+Y&cauthor_id=42929076)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#full-view-affiliation-1 "Department of Surgery, New Jahra Hospital, Al Jahra, Kuwait."), [Maximilian Peter Forssten](https://pubmed.ncbi.nlm.nih.gov/?term=Forssten+MP&cauthor_id=42929076)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#full-view-affiliation-2 "School of Medical Sciences, Orebro University, Orebro, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#full-view-affiliation-3 "Department of Orthopedic Surgery, Vasteras Central Hospital, Vasteras, Sweden."), [Susan Kartiko](https://pubmed.ncbi.nlm.nih.gov/?term=Kartiko+S&cauthor_id=42929076)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#full-view-affiliation-4 "The George Washington University, Washington, DC, USA."), [Hasan Mashabari](https://pubmed.ncbi.nlm.nih.gov/?term=Mashabari+H&cauthor_id=42929076)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#full-view-affiliation-1 "Department of Surgery, New Jahra Hospital, Al Jahra, Kuwait."), [Babak Sarani](https://pubmed.ncbi.nlm.nih.gov/?term=Sarani+B&cauthor_id=42929076)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#full-view-affiliation-5 "Center for Trauma and Critical Care, George Washington University, Washington DC, USA."), [Shahin Mohseni](https://pubmed.ncbi.nlm.nih.gov/?term=Mohseni+S&cauthor_id=42929076)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#full-view-affiliation-1 "Department of Surgery, New Jahra Hospital, Al Jahra, Kuwait.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#full-view-affiliation-2 "School of Medical Sciences, Orebro University, Orebro, Sweden.") Affiliations Expand ### Affiliations * 1 Department of Surgery, New Jahra Hospital, Al Jahra, Kuwait. * 2 School of Medical Sciences, Orebro University, Orebro, Sweden. * 3 Department of Orthopedic Surgery, Vasteras Central Hospital, Vasteras, Sweden. * 4 The George Washington University, Washington, DC, USA. * 5 Center for Trauma and Critical Care, George Washington University, Washington DC, USA. * PMID: **42929076** * DOI: [ 10.1177/00031348261499205 ](https://doi.org/10.1177/00031348261499205) Item in Clipboard # Ward Failure After Severe Rib Fracture: What Unplanned ICU Transfer Teaches Us About Early Risk Stratification Yousef AlHussaini et al. Am Surg. 2026. Show details Display options Display options Format Abstract PubMed PMID Am Surg Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Am+Surg%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Am+Surg%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42929076/) . 2026 Oct 26:31348261499205. doi: 10.1177/00031348261499205. Online ahead of print. ### Authors [Yousef AlHussaini](https://pubmed.ncbi.nlm.nih.gov/?term=AlHussaini+Y&cauthor_id=42929076)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#short-view-affiliation-1 "Department of Surgery, New Jahra Hospital, Al Jahra, Kuwait."), [Maximilian Peter Forssten](https://pubmed.ncbi.nlm.nih.gov/?term=Forssten+MP&cauthor_id=42929076)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#short-view-affiliation-2 "School of Medical Sciences, Orebro University, Orebro, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#short-view-affiliation-3 "Department of Orthopedic Surgery, Vasteras Central Hospital, Vasteras, Sweden."), [Susan Kartiko](https://pubmed.ncbi.nlm.nih.gov/?term=Kartiko+S&cauthor_id=42929076)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#short-view-affiliation-4 "The George Washington University, Washington, DC, USA."), [Hasan Mashabari](https://pubmed.ncbi.nlm.nih.gov/?term=Mashabari+H&cauthor_id=42929076)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#short-view-affiliation-1 "Department of Surgery, New Jahra Hospital, Al Jahra, Kuwait."), [Babak Sarani](https://pubmed.ncbi.nlm.nih.gov/?term=Sarani+B&cauthor_id=42929076)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#short-view-affiliation-5 "Center for Trauma and Critical Care, George Washington University, Washington DC, USA."), [Shahin Mohseni](https://pubmed.ncbi.nlm.nih.gov/?term=Mohseni+S&cauthor_id=42929076)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#short-view-affiliation-1 "Department of Surgery, New Jahra Hospital, Al Jahra, Kuwait.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42929076/#short-view-affiliation-2 "School of Medical Sciences, Orebro University, Orebro, Sweden.") ### Affiliations * 1 Department of Surgery, New Jahra Hospital, Al Jahra, Kuwait. * 2 School of Medical Sciences, Orebro University, Orebro, Sweden. * 3 Department of Orthopedic Surgery, Vasteras Central Hospital, Vasteras, Sweden. * 4 The George Washington University, Washington, DC, USA. * 5 Center for Trauma and Critical Care, George Washington University, Washington DC, USA. * PMID: **42929076** * DOI: [ 10.1177/00031348261499205 ](https://doi.org/10.1177/00031348261499205) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract BackgroundSevere rib fractures are a major cause of morbidity and mortality after blunt thoracic trauma. The decision to directly admit these patients to the intensive care unit (ICU) vs initial ward placement remains debated. An unplanned ICU transfer may reflect delayed recognition of deterioration and worsen outcomes.MethodsAdult patients (≥18 years) with isolated severe thoracic injury (thorax AIS ≥3, AIS ≤1 in all other body regions) due to blunt trauma that resulted in one or more rib fractures were identified in the ACS Trauma Quality Improvement Program database from 2013-2021. Patients were stratified by admission pathway: direct ICU admission or unplanned ICU transfer from the ward. The primary outcome was in-hospital mortality. Multivariable Poisson regression with robust standard errors was employed to adjust for potential confounding.ResultsAmong 52,332 patients who sustained isolated severe thoracic injury with rib fractures and were admitted to the ICU, 1830 (3.5%) experienced an unplanned ICU transfer. Adjusted analyses confirmed increased risks of mortality (RR 3.35, 95% CI 2.89-3.88), pneumonia (RR 2.68, 95% CI 2.08-3.45), ARDS (RR 4.52, 95% CI 3.42-5.97), and mechanical ventilation (RR 3.21, 95% CI 2.98-3.47) with unplanned admission.ConclusionsUnplanned ICU admission is independently associated with markedly worse outcomes in isolated severe thoracic injury with rib fractures. These findings suggest that improved early risk stratification may help identify patients at increased risk of subsequent unplanned ICU transfer. **Keywords:** intensive care unit; mortality; outcomes; rib fractures; severe thoracic injury. 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