A. X. Samayoa1, W. Alswealmeen1, R. Shadis1 1Abington Jefferson Health,Surgery,Abington, PA, USA
Introduction: Chest wall trauma in the elderly can be a devastating injury. Pulmonary complications, prolonged hospitalization, and disposition challenges are expected. The aim of the study is to compare the hospital course in isolated chest wall injuries in the extremes of the elderly.
Methods: We conducted a single institution retrospective review of prospectively collected data from 2000-2015. All patients were admitted to our suburban Level II trauma center with isolated chest wall trauma (rib fractures, chest wall contusions). Patients were divided into two age groups: A [65-84yo] and B [≥ 85yo]. Patient characteristics and outcomes data were collected.
Results: Two hundred sixteen patients were identified with isolated chest wall trauma. Of these, 134 were over 65 years of age, with 90 in Group A [age=76.9 ± 5.0y] and 44 in Group B [age=89.1±3.5y]. The most common mechanism of trauma was fall for both groups [Group A=71% vs Group B=84%] [p=0.135]. Rib fractures were the most common type of chest wall injury with 53% and 52% in Group A and B respectively [p=0.474]. Five percent of all patients required mechanical ventilation and no difference were found between groups [p=1.0]. The most common complications were pulmonary (pneumothorax, hemothorax, respiratory failure, pneumonia, etc.) and were present in 27% in Group A and 16% in Group B [P=0.195] (table1). Patients in Group A were more likely to be discharged home as compared to Group B [53% vs 30%] [P=0.010]. Group B patients were more likely to be discharged to a skilled nursing or rehabilitation facility as compared to Group A [59% vs 40%] [0.044] (Table 1). No difference was found in hospital mortality between groups [P=1.0] (table1).
Conclusion: Isolated chest wall trauma in the elderly confers significant morbidity. Most complications were pulmonary. Patients 85 years and older are more likely to be discharge to a skilled nurse facility. We feel that this study encompasses some important points on chest wall trauma in the elderly and a larger multicenter study would further validate these findings.
