Disposition of the adult patient with rib fractures

ICU: intensive care unit; SpO₂: oxygen saturation; RR: respiratory rate; COPD: chronic obstructive pulmonary disease; IS: incentive spirometry.

* No universally accepted definition of "severe rib fracture" exists. An increasing number of fractures and greater fracture complexity (eg, comminution, displacement) increases the risk of complications, but other factors (eg, comorbidity) are important. Refer to the UpToDate topic on the evaluation and management of rib fractures for additional details.

¶ Comorbidities such as frailty, COPD, and neuromuscular disease may contribute to development of respiratory compromise and should lower the threshold for ICU admission.

Δ Older patients are at increased risk of complications from rib fractures, but those who are not frail may be suitable for discharge. Frail older adults with comorbidities may be candidates for ICU admission even if they do not meet any explicit ICU admission criteria.

◊ Patient should be clinically deemed low risk for other injuries that would require admission or should have imaging to rule out other injuries. Refer to the UpToDate topic discussing outpatient care of rib fractures.