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Elderly Trauma Patients with Rib Fractures Are at Greater Risk of Death and Pneumonia

Bergeron, Eric MD; Lavoie, Andre PhD; Clas, David MD; Moore, Lynne MSc; Ratte, Sebastien MD; Tetreault, Stephane MD; Lemaire, Jacques PhD; Martin, Marcel MD

Journal of Trauma-Injury Infection & Critical Care: March 2003 - Volume 54 - Issue 3 - pp 478-485
Original Articles

Background : The purpose of this study was to show that elderly patients admitted with rib fractures after blunt trauma have increased mortality.

Methods : Demographic, injury severity, and outcome data on a cohort of consecutive adult trauma admissions with rib fractures to a tertiary care trauma center from April 1, 1993, to March 31, 2000, were extracted from our trauma registry.

Results : Among 4,325 blunt trauma admissions, there were 405 (9.4%) patients with rib fractures; 113 were aged ≥ 65. Injuries were severe, with Injury Severity Score (ISS) ≥ 16 in 54.8% of cases, a mean hospital stay of 26.8 ± 43.7 days, and 28.6% of patients requiring mechanical ventilation. Mortality (19.5% vs. 9.3%;p < 0.05), presence of comorbidity (61.1% vs. 8.6%;p < 0.0001), and falls (14.6% vs. 0.7%;p < 0.0001) were significantly higher in patients aged ≥ 65 despite significantly lower ISS (p = 0.031), higher Glasgow Coma Scale score (p = 0.0003), and higher Revised Trauma Score (p < 0.0001). After adjusting for severity (i.e., ISS and Revised Trauma Score), comorbidity, and multiple rib fractures, patients aged ≥ 65 had five times the odds of dying when compared with those < 65 years old.

Conclusion : 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.

From Choc-trauma Montérégie, Hôpital Charles-LeMoyne (E.B., A.L., D.C., S.R., S.T.), Centre hospitalier affilié universitaire de Québec (A.L., L.M.), and Université de Sherbrooke (M.M.), Quebec, Canada.

Submitted for publication April 13, 2001.

Accepted for publication August 24, 2002.

Presented at the 14th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 10–13, 2001, Tarpon Springs, Florida.

Address for reprints: Eric Bergeron, MD, Choc-trauma Montérégie, Hôpital-Charles-LeMoyne, 3120, boul. Taschereau, Greenfield Park, Quebec J4V 2H1, Canada; email: eric.bergeron@traumaquebec.org.

© 2003 Lippincott Williams & Wilkins, Inc.