Outcomes after rib fractures in geriatric blunt trauma patients

Abstract

Introduction: Rib fractures after blunt trauma contribute substantially to morbidity and mortality in the elderly.

Methods: Retrospective review of 255 patients ≥65 years old at a level 2 trauma center over 6 years, who sustained blunt trauma resulting in rib fractures. Outcomes measured include mortality, hospital length of stay(LOS), intensive care unit(ICU) admission, ICU LOS, need for MV, and MV days.

Results: There were 24 deaths (9.4%), of which 7 were early (<24 h). 130 patients (51%) were admitted to ICU, and 49 (19.2%) required MV. Mean ICU and MV days were 5.9 and 6.3, respectively. ICU admission was predicted by a base deficit <-2.0, ISS>15, bilateral rib fractures, pneumothorax or hemothorax on chest x-ray (All p < 0.001), as well as hypotension, GCS<15, and 1st rib fractures (All p < 0.05). Mortality was predicted by a base deficit < -5.0, GCS score of 3(Both p < 0.001), as well as hypotension, ISS≥25, RTS <7.0, bilateral pneumothoraces, 1st rib fractures, and >5 rib fractures (All p < 0.05).

Conclusion: Rib fractures in elderly blunt trauma patients are associated with significant mortality and morbidity, but outcomes can be predicted to improve care.