B. Zangbar1, S. Imtiyaz1, J. Yun1, L. Dresner1, V. Roudnitsky1, R. Gruessner1, P. Rhee2, B. Joseph2 1State University Of New York Downstate Medical Center,Brooklyn, NEW YORK, USA 2University Of Arizona,Surgery,Tucson, AZ, USA
Introduction: Rib fractures are known to increase the pulmonary complications and mortality in trauma patients. However the number of rib fractures associated with the increased mortality in elderly trauma patients is unknown. The aim of our study was to define the association between the number of rib fractures and mortality in elderly trauma patients.
Methods: We performed a 2-year study of National Trauma Data Bank (NTDB) on the elderly patients (≥ 65 years old) with isolated chest trauma (Other body AIS < 3) sustaining 1 or more rib fractures. Patients with open or closed sternum fracture, laryngeal injuries and flail chest were excluded. Data abstracted included the number of rib fractures by International Classification of Diseases-9 code, Injury Severity Score, Complications including: pneumonia, acute respiratory distress syndrome, pulmonary embolus, pneumothorax, the need for mechanical ventilation, number of ventilator days, intensive care unit (ICU) length of stay (LOS), hospital LOS, and mortality. Regression analysis was performed.
Results: A total of 32,563 elderly patients were identified with isolated chest trauma of which 27,209 (83.5%) patients sustaining 1 or more rib fractures were included in our study. Complication rate was 32.2% (n=8,774) and mortality rate was 3% (n=809). In a linear regression model after adjusting for age, gender, systolic blood pressure, heart rate, and GCS, number of ribs fractured independently correlated with hospital length of stay (β coefficient = 0.48, p < 0.001), ICU length of stay (β coefficient = 0.40, p < 0.001), and ventilator days (β coefficient = 0.16, p < 0.001). In multivariate logistic regression analyses, after adjusting for age, gender, systolic blood pressure, heart rate, and GCS, risk of mortality and complications increased incrementally when patients had more than 4 rib fractures. Male sex was independently associated with higher mortality ( p < 0.001) and complication (Odds Ratio = 1.61, 95% Confidence Interval = 1.39 – 1.88, p < 0.001) after isolated chest trauma.
Conclusion: Increasing the number of rib fractures correlated directly with increasing complications and mortality. Elderly patients sustaining more than 3 rib fracture are at risk of higher mortality and complications.
