Morbidity and Mortality After Rib Fracture in Elderly Patients (>65 Years Old) Compared to a Younger Cohort (≤65 Years of Age) at Doctor Hospital Renaissance Health

Abstract

Background: Traumatic rib fracture is a major cause of morbidity and mortality. Recent studies highlight the inadequacy of age and the number of rib fractures (NRFs) to assess patients' care needs, which may unnecessarily increase the burden of intensive care unit (ICU) admissions. Therefore, we sought to clarify the clinical outcomes of patients admitted to a level I trauma center with multiple blunt-trauma rib fractures by age and fracture location.Methods: We performed a retrospective cohort study of patients aged 18-95 admitted to Doctors Hospital at Renaissance Health with multiple rib fractures during 2017-2020. Patients with major vascular/cerebral injuries or emergency surgery from other injuries were excluded. The study population comprised 71 patients aged ≤65 and 53 patients aged >65 years. The primary study outcomes included mortality and non-home discharge. ICU length of stay (ICU-LOS), total hospital length of stay (HLOS), and days on the ventilator were the secondary outcomes. Study outcomes were also analyzed by stratifying patients by fracture location.Results: Patients aged >65 years with multiple blunt-trauma rib fractures had lower mortality rates despite a higher prevalence of comorbidities but with higher rates of non-home discharges compared to younger patients. However, the mortality and non-home discharge odds ratios were not statistically significant. Also, median ICU-LOS and HLOS were numerically higher in geriatric patients but were not statistically significant. Nonetheless, younger patients required significantly more days of respiratory support than older patients. Similar differences were observed in the clinical outcome of patients ≤65 or >65 years when stratified by fracture locations.Conclusion: Young patients with blunt trauma rib fractures may have similar, if not worse, clinical outcomes than geriatric patients. These findings underscore the need for individual assessment of the patient's trauma severity independent of age, the number of rib fractures, or fracture location to reduce ICU burden.

Rib fracture secondary to cough‐induced trauma

“…Older patients often have decreased bone density due to conditions like osteoporosis, making their ribs more susceptible to fractures even with minor trauma. 10 Complications of rib fractures include pneumothorax, hemothorax, pulmonary contusion, and rib displacement leading to lung injury, managed through pain control, respiratory support if necessary, chest physiotherapy, rib fracture stabilization with splinting or bracing, and monitoring for and treating complications such as pneumothorax or hemothorax. writing -review and editing.…”

“…Studies have shown that an increased number of fractured ribs is associated with higher mortality rates, particularly in older individuals. Older patients often have decreased bone density due to conditions like osteoporosis, making their ribs more susceptible to fractures even with minor trauma 10 …”

Comparative study of wound outcomes and surgical strategies: Internal fixation versus external stabilization in rib fracture patients with traumatic chest wounds

“…These complications impose the substantial financial burden on healthcare systems and have particularly detrimental effect on the elderly, who have a higher risk of developing complications. 4,5 Rib fractures are not limited to skeletal injuries within the clinical environment; they can also cause substantial harm to soft tissues, especially when they are accompanied by traumatic chest wounds. These injuries manifest as sudden discomfort that is worsened by respiratory actions and have the potential to greatly hinder pulmonary function.…”

External validation of novel Revised Intensity Battle Score and comparison of static rib fracture scoring systems

“…However, more recent evidence has questioned this paradigm, especially in the pan-scan era. [23][24][25][26][27][28] In the development of the RIBS, age was offered to the model as a candidate predictor at every step given its historical significance, and was consistently cut from the model due to providing no significant predictive power. This validation study will reexamine the issue of age and its impact on predicting complications once again.…”

“…There is an abundance of historical evidence for the role of age 2,3,14–22 in predicting morbidity, mortality, pneumonia and prolonged length of stay. However, more recent evidence has questioned this paradigm, especially in the pan-scan era 23–28 . In the development of the RIBS, age was offered to the model as a candidate predictor at every step given its historical significance, and was consistently cut from the model due to providing no significant predictive power.…”