Journal ArticleDOI
Rib fractures in the elderly.
TLDR
Elderly patients who sustain blunt chest trauma with rib fxs have twice the mortality and thoracic morbidity of younger patients with similar injuries, and a significant increase in morbidity and mortality in both groups, but with different patterns for each group.Abstract:
BACKGROUND: We sought to ascertain the extent to which advanced age influences the morbidity and mortality after rib fractures (fxs), to define the relationship between number of rib fractures and morbidity and mortality, and to evaluate the influence of analgesic technique on outcome. METHODS: A retrospective cohort study involving all 277 patients > or = 65 years old with rib fxs admitted to a Level I trauma center over 10 years was undertaken. The control group consisted of 187 randomly selected patients, 18 to 64 years old, with rib fxs admitted over the same time period. Outcomes included pulmonary complications, number of ventilator days, length of intensive care unit and hospital stay (LOS), disposition, and mortality. The specific analgesic technique used was also examined. RESULTS: The two groups had similar mean number of rib fxs (3.6 elderly vs. 4.0 young), mean chest Abbreviated Injury Scores (3.0 vs. 3.0), and mean Injury Severity Score (20.7 vs. 21.4). However, mean number of ventilator days (4.3 vs. 3.1), intensive care unit days (6.1 vs. 4.0), and LOS (15.4 vs. 10.7 days) were longer for the elderly patients. Pneumonia occurred in 31% of elderly versus 17% of young (p 2 days) was associated with a 10% mortality versus 16% without the use of an epidural (p = 0.28). In the younger group (LOS >2 days), mortality with and without the use of an epidural was 0% and 5%, respectively. CONCLUSION: Elderly patients who sustain blunt chest trauma with rib fxs have twice the mortality and thoracic morbidity of younger patients with similar injuries. For each additional rib fracture in the elderly, mortality increases by 19% and the risk of pneumonia by 27%. As the number of rib fractures increases, there is a significant increase in morbidity and mortality in both groups, but with different patterns for each group. Further prospective study is needed to determine the utility of epidural analgesia in this population.read more
Citations
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Journal ArticleDOI
A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management
TL;DR: The greater the number of fractured ribs, the higher the mortality and morbidity rates and elderly patients with six or more fractured ribs should be treated in intensive care units due to high morbidity and mortality.
Journal ArticleDOI
Half-a-dozen ribs: The breakpoint for mortality
Benjamin T. Flagel,Fred A. Luchette,R. Lawrence Reed,Thomas J. Esposito,Kimberly A. Davis,John M. Santaniello,Richard L. Gamelli +6 more
TL;DR: The National Trauma Data Bank (NTDB, v. 3.0 American College of Surgeons, Chicago, IL) was queried for patients sustaining 1 or more rib fractures.
Journal ArticleDOI
Elderly trauma patients with rib fractures are at greater risk of death and pneumonia
Eric Bergeron,André Lavoie,David Clas,Lynne Moore,Sebastien Ratte,Stephane Tetreault,Jacques Lemaire,Marcel Martin +7 more
TL;DR: Despite lower indices of injury severity, even after taking account of comorbidities, mortality was significantly increased in elderly patients admitted to a trauma center with rib fractures.
Journal ArticleDOI
Morbidity from rib fractures increases after age 45
TL;DR: Patients over the age of 45 with more than four rib fractures are more severely injured and at increased risk of adverse outcomes, and efforts to decrease rib fracture morbidity should focus not only on elderly patients but those as young as 45 years.
Journal ArticleDOI
Risk factors that predict mortality in patients with blunt chest wall trauma: A systematic review and meta-analysis
TL;DR: The risk factors for mortality in patients sustaining blunt chest wall trauma were a patient age of 65 years or more, three or more rib fractures and the presence of pre-existing disease especially cardiopulmonary disease.
References
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Journal ArticleDOI
The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care
TL;DR: Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma.
Journal ArticleDOI
Abbreviated Injury Scale and Injury Severity Score: a scoring chart.
TL;DR: The Trauma Chart provided is a simple and concise guide for scoring and recording this useful information in both a large wall-mounted form and a reduced two-page form.
Journal ArticleDOI
The morbidity and mortality of rib fractures.
TL;DR: It is concluded that rib fractures are a marker of severe injury in which 12% will die because of their injuries and one half will require operative and ICU care, and one third will require discharge to an extended care facility.
Journal ArticleDOI
The Effect of Preexisting Conditions on Mortality in Trauma Patients
TL;DR: Investigation of the effects of preexisting chronic conditions on in-hospital mortality in adult trauma patients in California provided statistical evidence to support the recommendation of the American College of Surgeons that the presence of underlying disease be considered in decisions to triage and transfer patients to trauma centers.
Journal ArticleDOI
A case control study for major trauma in geriatric patients.
TL;DR: Cost data showed that the DRG prospective payment system grossly underestimated the cost of care for elderly major trauma patients and triaging elderly trauma victims to trauma centers at a much lower threshold than similarly injured younger patients is recommended.