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Morbidity from rib fractures increases after age 45
John B Holcomb1, Neil R McMullin, Rosemary A Kozar
1Department of Surgery, University of Texas Health Sciences Center, Houston, TX, USA.
Journal of the American College of Surgeons
|April 15, 2003
Summary
Older patients with multiple rib fractures face higher risks. This study highlights that individuals aged 45 and above with more than four rib fractures experience increased adverse outcomes after blunt chest trauma.
Area of Science:
- Trauma Surgery
- Geriatric Medicine
- Critical Care Medicine
Background:
- Elderly patients with rib fractures after blunt trauma exhibit increased morbidity.
- A multidisciplinary clinical pathway for rib fractures is being developed.
- This study investigates the link between age, rib fracture count, and adverse outcomes in blunt chest trauma.
Purpose of the Study:
- To determine the relationship between increasing age, number of rib fractures, and adverse outcomes.
- To identify patient groups at higher risk for complications following blunt chest trauma.
Main Methods:
- Retrospective cohort study of blunt trauma patients over 15 years old with rib fractures.
- Exclusion of patients with Abbreviated Injury Scores (AIS) > 2 for abdomen and head.
- Analysis of outcomes including Injury Severity Score (ISS), pulmonary complications, ventilator days, ICU and hospital length of stay.
Main Results:
- 171 out of 6,096 patients met inclusion criteria.
- Patients aged 45+ with >4 rib fractures (Group 4) showed increased ventilator days, ICU days, and total hospital stay (p < 0.05).
- Pulmonary contusions and hemopneumothorax incidence were similar across groups; mortality was not significantly different.
Conclusions:
- Patients aged 45 and older with more than four rib fractures are at increased risk of adverse outcomes.
- Focusing on reducing rib fracture morbidity should include patients as young as 45.
- A multidisciplinary clinical pathway has been initiated for patients aged 45+ with >4 rib fractures.