Older Adults With Isolated Rib Fractures Do Not Require Routine Intensive Care Unit Admission

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Abstract

Background: Older adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care. Materials and methods: We analyzed patients ≥50 y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs. Results: Among 401 patients, 251 (63%) were admitted to an ICU. Eighty-three patients (33%) admitted to an ICU and 7 (5%) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10%), frequent respiratory therapy (9%), and oxygen desaturation (8%). Predictors of CCIEs included incentive spirometry <1 L (OR 4.72, 95% CI 2.14-10.45); use of a walker (OR 2.86, 95% CI 1.29-6.34); increased chest Abbreviated Injury Scale score (AIS 3 OR 5.83, 95% CI 2.34-14.50); age ≥72 y (OR 2.68, 95% CI 1.48-4.86); and active smoking (OR 2.11, 95% CI 1.06-4.20). Conclusions: Routine ICU admission is not necessary for most older adults with isolated rib fractures. The predictors we identified warrant prospective evaluation for development of a clinical decision rule to preclude unnecessary ICU admissions.

Original languageEnglish (US)
Pages (from-to)492-499
Number of pages8
JournalJournal of Surgical Research
Volume245
DOIs
StatePublished - Jan 1 2020

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Rib Fractures
Intensive Care Units
Critical Care
Abbreviated Injury Scale
Guidelines
Respiratory Therapy
Thoracic Injuries
Spirometry
Intubation
Hypotension
Motivation
Logistic Models
Smoking
Oxygen
Morbidity
Mortality

Keywords

  • Intensive care unit
  • Older adult
  • Rib fracture

ASJC Scopus subject areas

  • Surgery

Cite this

@article{0f9f1d5538bd4d88970add83f452cd19,
title = "Older Adults With Isolated Rib Fractures Do Not Require Routine Intensive Care Unit Admission",
abstract = "Background: Older adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care. Materials and methods: We analyzed patients ≥50 y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs. Results: Among 401 patients, 251 (63{\%}) were admitted to an ICU. Eighty-three patients (33{\%}) admitted to an ICU and 7 (5{\%}) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10{\%}), frequent respiratory therapy (9{\%}), and oxygen desaturation (8{\%}). Predictors of CCIEs included incentive spirometry <1 L (OR 4.72, 95{\%} CI 2.14-10.45); use of a walker (OR 2.86, 95{\%} CI 1.29-6.34); increased chest Abbreviated Injury Scale score (AIS 3 OR 5.83, 95{\%} CI 2.34-14.50); age ≥72 y (OR 2.68, 95{\%} CI 1.48-4.86); and active smoking (OR 2.11, 95{\%} CI 1.06-4.20). Conclusions: Routine ICU admission is not necessary for most older adults with isolated rib fractures. The predictors we identified warrant prospective evaluation for development of a clinical decision rule to preclude unnecessary ICU admissions.",
keywords = "Intensive care unit, Older adult, Rib fracture",
author = "Bowman, {Jessica A.} and Gregory Jurkovich and Daniel Nishijima and Utter, {Garth H}",
year = "2020",
month = "1",
day = "1",
doi = "10.1016/j.jss.2019.07.098",
language = "English (US)",
volume = "245",
pages = "492--499",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

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TY - JOUR

T1 - Older Adults With Isolated Rib Fractures Do Not Require Routine Intensive Care Unit Admission

AU - Bowman, Jessica A.

AU - Jurkovich, Gregory

AU - Nishijima, Daniel

AU - Utter, Garth H

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Older adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care. Materials and methods: We analyzed patients ≥50 y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs. Results: Among 401 patients, 251 (63%) were admitted to an ICU. Eighty-three patients (33%) admitted to an ICU and 7 (5%) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10%), frequent respiratory therapy (9%), and oxygen desaturation (8%). Predictors of CCIEs included incentive spirometry <1 L (OR 4.72, 95% CI 2.14-10.45); use of a walker (OR 2.86, 95% CI 1.29-6.34); increased chest Abbreviated Injury Scale score (AIS 3 OR 5.83, 95% CI 2.34-14.50); age ≥72 y (OR 2.68, 95% CI 1.48-4.86); and active smoking (OR 2.11, 95% CI 1.06-4.20). Conclusions: Routine ICU admission is not necessary for most older adults with isolated rib fractures. The predictors we identified warrant prospective evaluation for development of a clinical decision rule to preclude unnecessary ICU admissions.

AB - Background: Older adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care. Materials and methods: We analyzed patients ≥50 y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs. Results: Among 401 patients, 251 (63%) were admitted to an ICU. Eighty-three patients (33%) admitted to an ICU and 7 (5%) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10%), frequent respiratory therapy (9%), and oxygen desaturation (8%). Predictors of CCIEs included incentive spirometry <1 L (OR 4.72, 95% CI 2.14-10.45); use of a walker (OR 2.86, 95% CI 1.29-6.34); increased chest Abbreviated Injury Scale score (AIS 3 OR 5.83, 95% CI 2.34-14.50); age ≥72 y (OR 2.68, 95% CI 1.48-4.86); and active smoking (OR 2.11, 95% CI 1.06-4.20). Conclusions: Routine ICU admission is not necessary for most older adults with isolated rib fractures. The predictors we identified warrant prospective evaluation for development of a clinical decision rule to preclude unnecessary ICU admissions.

KW - Intensive care unit

KW - Older adult

KW - Rib fracture

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U2 - 10.1016/j.jss.2019.07.098

DO - 10.1016/j.jss.2019.07.098

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VL - 245

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JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -