Major Risk Factors for Mortality in Elderly and Non-Elderly Adult Patients Emergently Admitted for Blunt Chest Wall Trauma: Hospital Length of Stay as an Independent Predictor

Abstract

Background: Blunt thoracic trauma is responsible for 35% of trauma-related deaths in the United States and significantly contributes to morbidity and healthcare-related financial strain. The goal of this study was to evaluate factors influencing mortality in patients emergently admitted with the primary diagnosis of blunt chest wall trauma. Methods: Adults emergently admitted for blunt chest trauma were assessed using the National Inpatient Sample Database, 2004–2014. Data regarding demographics, comorbidities, and outcomes were collected. Relationships were determined using univariable and multivariable logistic regression models. Results: In total, 1120 adult and 1038 elderly patients emergently admitted with blunt chest trauma were assessed; 46.3% were female, and 53.6% were male. The average ages of adult and elderly patients were 46.6 and 78.9 years, respectively. Elderly and adult patients both displayed mortality rates of 1%. The regression model showed HLOS and several comorbidities as the main risk factors of mortality Every additional day of hospitalization increased the odds of mortality by 9% (OR = 1.09, 95% CI = 1.01–1.18, p = 0.033). Mortality and liver disease were significantly associated (OR = 8.36, 95% CI = 2.23–31.37, p = 0.002). Respiratory disease and mortality rates demonstrated robust correlations (OR = 7.46, 95% CI = 1.63–34.11, p = 0.010). Trauma, burns, and poisons were associated with increased mortality (OR = 3.72, 95% CI = 1.18–11.71, p = 0.025). The presence of platelet/white blood cell disease correlated to higher mortality. (OR = 4.42, 95% CI = 1.09–17.91, p = 0.038).

Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients

“…Specifically, there was a 7.7% increase in the odds of mortality for each additional day spent in the hospital. Similarly, associations between mortality and HLOS were noted in multiple recent retrospective studies on patients emergently admitted with gastroparesis, hemorrhoids, duodenal ulcers, blunt chest wall trauma, tracheostomy, rectal malignancy, total hip arthroplasty, and paralytic ileus [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. The HLOS was not a significant predictor for mortality in the elderly sample, despite elderly patients experiencing a longer HLOS ( Table 2 ).…”

Elderly Patients Managed Non-Operatively with Abscesses of the Anorectal Region Have Five Times Higher Rate of Mortality Compared to Non-Elderly

“…Longer hospital length of stay has been shown to be detrimental in many diverse conditions [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 30 , 33 , 34 ]. Interestingly, for patients with ruptured abdominal aortic aneurysm, longer hospital length of stay was inversely correlated with mortality and thus improved outcomes [ 35 ].…”

“…The database was created by AHRQ (the Agency for Healthcare Research and Quality), which has been frequently used nationally as a public data source for analysis of variegated types and qualities of patient care and their associated results. This has allowed us to perform a comprehensive and holistic path to research diseases, a path to the ideal way to treat and care for patients with those diseases, and ultimately a path to find how patients respond to both the diseases and treatments [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. The NIS database includes certain weighting when constructing its sample of discharges and it excludes long-term acute care facilities and rehabilitation centers.…”

Risk Factors for Mortality in Emergently Admitted Patients with Acute Gastric Ulcer: An Analysis of 15,538 Patients in National Inpatient Sample, 2005–2014

“…This can help explain our findings as HLOS can be used as a predictor for mortality in adult and elderly patients who did not undergo surgery for gastric ulcer. In fact, in the general literature, HLOS is associated with mortality in surgical patients admitted emergently due to other medical conditions, such as bleeding gastritis, blunt force trauma, tracheostomy, etc., whereas one study found a reverse relationship between HLOS and mortality for emergently admitted patients with ruptured abdominal aortic aneurysms [ 35 , 36 , 37 , 38 , 39 ]. A few recent retrospective cohort studies analyzed patients with phlebitis/thrombophlebitis, acute pancreatitis, C. difficile colitis, and colon cancer, which found a significant increase in odds of mortality after day 4, 6, 6, and 15 of admission, respectively [ 40 , 41 , 42 , 43 ].…”

“…Several authors also found significant positive correlations between comorbidity and mortality [ 16 , 17 , 26 , 27 , 30 ]. In particular, some authors have specifically found respiratory diseases, liver disease and cardiac disease as important comorbidities affecting their respective medical conditions [ 38 , 44 ]. Our study found these same comorbidities to be significant as well.…”