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Published on: November 8, 2024
Rib Fracture Injury Guidelines for Patients Over the Age of 65: Should These Patients Routinely Be Admitted to the
Adam C Fields1, Manuel Castillo-Angeles1, Matthew R Bryan2
1Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Introduction:
The 2022 Eastern Association for the Surgery of Trauma guidelines state there is insufficient data to recommend intensive care unit (ICU) versus non-ICU admission for patients older than 65 y with > 3 rib fractures. This study aims to identify factors leading to worse outcomes to ultimately create a new admission triage algorithm for older adult patients with rib fractures.
Methods:
Patients aged 65 y or older with ≥ 3 rib fractures were identified between 2016 and 2023 using our institutional trauma database. Patient demographics, comorbidities, and injury characteristics were collected. The primary outcome was predictors of a composite negative outcome (mortality, pneumonia, and readmission to ICU).
Results:
A total of 495 patients were included, with 340 patients admitted to the ICU and 155 patients admitted to the floor. Multivariable analysis demonstrated that frailty (odds ratio [OR]: 11.82, P < 0.001), ≥ 5 rib fractures (OR: 2.64, P = 0.04), chest tube placement (OR: 3.31, P = 0.04), and regional nerve block (OR: 4.66, P = 0.001) were all associated with worse outcomes.
Conclusions:
Patients with blunt thoracic trauma who are ≥ 65 y, frail, and have ≥ 5 rib fractures may benefit from ICU admission. Future studies will assess the validity of a new proposed admission triage algorithm.
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