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Observational Study
. 2019 Aug;45(4):575-583.
doi: 10.1007/s00068-018-0969-9. Epub 2018 Jun 15.

Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study

Mark G Van Vledder  1 , Vicky Kwakernaak  2 , Tjebbe Hagenaars  2 , Esther M M Van Lieshout  2 , Michiel H J Verhofstad  2 ; South West Netherlands Trauma Region Study Group
Collaborators, Affiliations
Observational Study

Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study

Mark G Van Vledder et al. Eur J Trauma Emerg Surg. 2019 Aug.

Abstract

Background: High rates of pneumonia and death have been reported among elderly patients with rib fractures. This study aims to identify patterns of injury and risk factors for pneumonia and death in elderly patients with rib fractures.

Methods: A retrospective multicenter observational study was performed using data registered in the national trauma registry between 2008 and 2015 in the South West Netherlands Trauma region. Data regarding demographics, mechanism of injury, pulmonary and cardiovascular history, pattern of extra-thoracic and intrathoracic injuries, ICU admission, length of stay, and morbidity and mortality following admission were collected.

Results: Eight hundred eighty-four patients were included. Median age was 76 years (P25-P75 70-83). 235 patients (26.6%) were 81 years or older. Moderate or worse extra-thoracic injuries were present in 456 patients (51.6%), of whom 146 (16.6%) had severe head injuries and 45 (5.1%) severe spinal injuries. Median ISS was 9 (P25-P75 5-18). The rate of pneumonia was 10% (n = 84). Ten percent of patients (n = 88) died. Risk factors for in-hospital mortality included age (OR 3.4; p = 0.003), presence of COPD (OR 1.3; p = 0.01), presence of cardiac disease (OR 2.6; p = 0.003), severe or worse head (OR 3.5; p < 0.001), abdominal (OR 6.8; p = 0.004) and spinal injury (OR 4.6; p = 0.011) by AIS, number of rib fractures (OR 2.6; p = 0.03), and need for chest tube drainage (OR 2.1; p = 0.021).

Conclusions: Pneumonia and death occur in about 10% of elderly patients with rib fractures. Apart from the severity of thoracic injuries, the presence and severity of extra-thoracic injuries and cardiopulmonary comorbidities are associated with poor outcome.

Keywords: Geriatric trauma; Registry study; Rib fractures.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of patients included and excluded in the analysis
See this image and copyright information in PMC

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