Intensive care unit versus nonintensive care unit length of stay and clinical outcomes: A systematic review of randomized controlled trials in patients with rib fracture

Background and Objectives: Rib fractures are associated with considerable morbidity and healthcare costs and often require specialized care. This systematic review evaluated randomized controlled trials (RCTs) comparing intensive care unit (ICU) and non-ICU length of stay (LOS) and clinical outcomes to identify optimal management strategies for patients with rib fractures. Methods: A systematic search of PubMed/MEDLINE was conducted to identify RCTs published in English up to November 2024. Eligible studies included adult patients (≥18 years) with rib fractures and reported outcomes such as ICU and non-ICU LOS, complications, and mortality. Two independent reviewers conducted study selection, data extraction, and quality assessment, with discrepancies resolved by consensus. Due to heterogeneity in study design and outcomes, a narrative synthesis was performed. Results: The search identified 970 records, with an additional 43 from gray literature. After screening 260 full-text articles, 13 met the inclusion criteria. Patients had an average of 3–11 rib fractures, with common comorbidities including chronic obstructive pulmonary disease, hypertension, and diabetes. ICU stay was generally shorter than non-ICU stay, particularly among patients undergoing surgical or interventional management. Pulmonary complications, especially pneumonia, were common, although the overall mortality was low. No significant differences in long-term quality of life were observed between groups. Conclusion: This review highlights the need for evidence-based guidelines for rib fractures management. ICU care appears beneficial for improving monitoring and pain management, reducing complications, and supporting informed clinical decision-making, and resource allocation to enhance patient outcomes.