Factors Associated with Hospital Length of Stay and Interhospital Transfer in Patients with Rib Fractures: A Retrospective Study Using the Japan Trauma Data Bank
- 1Department of Legal Medicine, Shiga University of Medical Science, Shiga 520-2192, Japan
- 2Critical Care Center, Emergency Medicine, Kyoto Medical Center, Kyoto 612-8555, Japan
- 3Critical Care Center, Emergency Medicine, Kyoto Daini Red Cross Hospital, Kyoto 602-8026, Japan
Abstract
Background/Objectives: Patient characteristics and concomitant injuries may influence hospital length of stay (LOS) and discharge disposition after rib fractures. We examined these associations in a selected Japanese trauma-registry population. Methods: This retrospective study used Japan Trauma Data Bank records from 2019–2021. Adult survivors with target rib-fracture Abbreviated Injury Scale (AIS) codes, no additional recorded chest AIS codes, and maximum extra-chest AIS < 2 were included; recorded chest compressions were excluded. The one- or two-rib and three-or-more-rib groups were analyzed separately using negative binomial regression for recorded index-hospital LOS and Firth logistic regression for transfer versus home discharge. Results: Eligible samples comprised 149 and 787 patients; updated complete-case LOS samples were 126 and 694, and transfer samples were 142 and 702. In the linear-summary models, the adjusted LOS ratio for two versus one fractured rib was 1.936 (95% CI, 1.227–3.055). In the larger cohort, the ratios were 1.231 (1.156–1.310) per 10 years of age and 0.796 (0.722–0.879) per Glasgow Coma Scale (GCS) point. Adjusted transfer odds ratios per Charlson Comorbidity Index (CCI) point were 2.630 (1.531–4.960) and 1.278 (1.109–1.479). Flexible-age analyses indicated nonlinearity for LOS in the smaller cohort and transfer in the larger cohort. Some estimates changed with eligibility criteria and model specification. Conclusions: Associations with recorded LOS and interhospital transfer were observed among selected survivors, but their interpretation is limited by selection, incomplete data, unmeasured institutional and functional characteristics, and model sensitivity. These exploratory results do not establish causal effects or validated clinical decision rules.
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BibTeX
@article{motohama2026factors,
title = {{Factors Associated with Hospital Length of Stay and Interhospital Transfer in Patients with Rib Fractures: A Retrospective Study Using the Japan Trauma Data Bank}},
author = {Keisuke Motohama and Wataru Ishii and Mami Nakamura and Kosai Cho and Masahito Hitosugi},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218728},
url = {https://www.mdpi.com/2077-0383/15/21/8728},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Factors Associated with Hospital Length of Stay and Interhospital Transfer in Patients with Rib Fractures: A Retrospective Study Using the Japan Trauma Data Bank
AU - Keisuke Motohama
AU - Wataru Ishii
AU - Mami Nakamura
AU - Kosai Cho
AU - Masahito Hitosugi
PY - 2026
DA - 2026/11/09
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218728
UR - https://www.mdpi.com/2077-0383/15/21/8728
AB - Background/Objectives: Patient characteristics and concomitant injuries may influence hospital length of stay (LOS) and discharge disposition after rib fractures. We examined these associations in a selected Japanese trauma-registry population. Methods: This retrospective study used Japan Trauma Data Bank records from 2019–2021. Adult survivors with target rib-fracture Abbreviated Injury Scale (AIS) codes, no additional recorded chest AIS codes, and maximum extra-chest AIS < 2 were included; recorded chest compressions were excluded. The one- or two-rib and three-or-more-rib groups were analyzed separately using negative binomial regression for recorded index-hospital LOS and Firth logistic regression for transfer versus home discharge. Results: Eligible samples comprised 149 and 787 patients; updated complete-case LOS samples were 126 and 694, and transfer samples were 142 and 702. In the linear-summary models, the adjusted LOS ratio for two versus one fractured rib was 1.936 (95% CI, 1.227–3.055). In the larger cohort, the ratios were 1.231 (1.156–1.310) per 10 years of age and 0.796 (0.722–0.879) per Glasgow Coma Scale (GCS) point. Adjusted transfer odds ratios per Charlson Comorbidity Index (CCI) point were 2.630 (1.531–4.960) and 1.278 (1.109–1.479). Flexible-age analyses indicated nonlinearity for LOS in the smaller cohort and transfer in the larger cohort. Some estimates changed with eligibility criteria and model specification. Conclusions: Associations with recorded LOS and interhospital transfer were observed among selected survivors, but their interpretation is limited by selection, incomplete data, unmeasured institutional and functional characteristics, and model sensitivity. These exploratory results do not establish causal effects or validated clinical decision rules.
SN - 2077-0383
ER -