Article Text
Abstract
Background Patients older than 65 years have 2–5 times higher mortality if they sustain ≥2 rib fractures compared to younger adults. As a result, our level I trauma center guidelines suggest that older adults with rib fractures be admitted to the intensive care unit for the first 24 hours. In this study, we evaluated the outcomes associated with these guidelines.
Methods We retrospectively reviewed all patients aged ≥65 years in our Trauma Registry who sustained rib fractures from January 2008 to March 2015. Data included demographics, comorbidities, injuries, length of intensive care and hospital stay (LOS), ventilator days, analgesic used, morbidity, mortality, and disposition.
Results 97 patients aged ≥65 years with at least one rib fracture and an Abbreviated Injury Score of ≤2 for other regions were admitted. Falls caused 58% of the injuries, while motor vehicle collisions (MVC) accounted for 33%. Overall mortality was 4%. Patients who fell had a median hospital LOS that was 0.5 to 1 day longer than in those who suffered other mechanisms of injury or were involved in an MVC respectively. Patients aged ≥70 years had a median LOS of 4 days, twice that of those aged 65 to 69 years. Of the 87 patients with more than one rib fracture, 59 (68%) were not admitted directly to the intensive care unit (ICU) from the emergency department as recommended by our guidelines. 6 of these 59 patients (9%) were later transferred to the ICU and 2 of these patients expired.
Conclusions Although overall compliance with the geriatric rib fracture guideline was low, both mortality and hospital LOS were low in this group. This suggests that the guideline could be modified to reduce ICU resource usage without compromising patient outcomes.
Level of evidence Level III, retrospective cohort study.
- Geriatric
- rib fractures
- intensive care unit
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Footnotes
Presented at: Academic Surgical Congress Jacksonville, FL, USA 2–4 February 2016.
Contributors DAS, ME and HHS had full access to all the data and take responsibility for the integrity of the data and the accuracy of the data analysis. HHS, ME and DAS participated in study concept and design. HHS, ME, DAS and KLS participated in acquisition, analysis or interpretation of data. HHS, DAS and ME participated in drafting of the manuscript. All authors participated in critical revision of the manuscript for important intellectual content. HHS and ME participated in statistical analysis.
Funding KLS is supported by NIH/NIA 1K08AG04442801A1 and The Gordon and Betty Moore Faculty Scholarship.
Competing interests None declared.
Ethics approval The study was approved by IRB committee.
Provenance and peer review Not commissioned; externally peer reviewed.