Rib Fractures in the Elderly: a Marker of Injury Severity

Objectives: To examine the relationship between the number of rib fractures (RIBFs) and mortality, injury severity, and resource consumption in elderly patients admitted to trauma centers.

Design: Thirteen-year retrospective statewide database analysis.

Setting: Participating trauma centers in Pennsylvania.

Participants: A total of 27,855 trauma patients, including 8,648 elderly patients, admitted to a trauma center with more than one RIBF.

Measurements: Patient demographics, number of RIBFs, Injury Severity Score, complications, patient mortality, preexisting conditions (PECs), and hospital and intensive care unit length of stay.

Results: Mortality for elderly patients (aged>/=65) with RIBFs was greater than for patients younger than 65 (20.1% vs 11.4%, P<.001). Mortality rates increased with increasing numbers of RIBFs for both age groups and were always significantly higher in elderly trauma patients. The effect of PECs on patient mortality was inversely related to number of RIBFs and was most pronounced for patients with four or more RIBFs. Seven of 10 complications were more common in elderly patients despite lower mean+/-standard deviation Injury Severity Score (19.4+/-13.4 vs 23.2+/-14.2, P<.001).

Conclusion: Overall trauma-related mortality is higher in elderly patients with RIBFs than younger patients with RIBFs. Mortality rates rise with increasing number of RIBFs. The number of RIBFs is easy to quantify and may be a useful predictor of overall injury severity and outcome for elderly trauma patients.