The impact of rib fractures in the elderly

M. A. Arneson, E. M. Bulger, Gregory Jurkovich, C. Mock

Research output: Contribution to journalArticle

Abstract

Introduction: Rib fractures are common following blunt trauma. The elderly appear to be more susceptible to rib fractures, and may have worsened outcome following rib fractures. The purpose of this study was to ascertain the extent to which advanced age influences the morbidity and mortality following rib fractures. We also sought to determine the influence of analgesic technique on outcome. Methods: A retrospective cohort study was undertaken. All patients > 65 years with rib fractures admitted to a Level 1 trauma center were identified. A control group of randomly selected patients age 18-64 years with rib fractures admitted during the same time period was also identified. Outcomes which were evaluated included: thoracic complications, ventilator days, ICU length of stay, disposition and mortality. The effect of analgesic techniques on outcome was specifically addressed. Results: There were 277 patients ≥ 65 years admitted with rib fractures over this time period. The control group of 187 patients aged 18-64 years was randomly selected from the total rib fracture population in this age group admitted during this time period. Males accounted for 57% of the elderly patients and 70% of the younger cohort. MVA (60%), falls (19%), and auto-pedestrian (16%) were the principle mechanisms of injury in the elderly, compared to MVA (60%), falls (14%) and crush (8%) in the young. A single rib fracture occurred in 49 (18%) of the elderly and 39 (21%) of the young. The two groups had similar injury distribution by AIS score and overall injury severity, but significantly different outcomes. N Age, yrs # Rib Fxs Chest AIS ISS Pneumonia * Mortality * Elderly 277 74±6 3.6±2.5 2.9 20.7 31% 22% Young 187 39±13 4.0±2.9 3.0 21.4 17% 10% * p<0.01, Chi-square Intubated days (4.5 days for elderly vs. 2.7 days for young), ICU days (6.1 vs. 4.0), and total hospital stay (15.4 vs. 10.7) were also significantly longer in the elderly patients (p<0.05 for all). The use of epidural analgesic in the elderly was associated with and 11% mortality, compared to a 25% mortality without use of epidural (p=0.05). Conclusions: Despite similar injury patterns and injury severity, elderly patients who sustain blunt chest trauma with rib fractures have twice the mortality and thoracic morbidity than younger patients. The use of epidural analgesic appears advantageous in both populations.

Original languageEnglish (US)
JournalJournal of Investigative Medicine
Volume47
Issue number2
StatePublished - Jan 1 1999
Externally publishedYes

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Rib Fractures
Analgesics
Mortality
Wounds and Injuries
Thorax
Intensive care units
Length of Stay
Morbidity
Control Groups
Injury Severity Score
Trauma Centers
Ribs
Mechanical Ventilators
Population
Pneumonia
Cohort Studies
Retrospective Studies
Age Groups

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Arneson, M. A., Bulger, E. M., Jurkovich, G., & Mock, C. (1999). The impact of rib fractures in the elderly. Journal of Investigative Medicine, 47(2).

The impact of rib fractures in the elderly. / Arneson, M. A.; Bulger, E. M.; Jurkovich, Gregory; Mock, C.

In: Journal of Investigative Medicine, Vol. 47, No. 2, 01.01.1999.

Research output: Contribution to journalArticle

Arneson, MA, Bulger, EM, Jurkovich, G & Mock, C 1999, 'The impact of rib fractures in the elderly', Journal of Investigative Medicine, vol. 47, no. 2.
Arneson, M. A. ; Bulger, E. M. ; Jurkovich, Gregory ; Mock, C. / The impact of rib fractures in the elderly. In: Journal of Investigative Medicine. 1999 ; Vol. 47, No. 2.
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abstract = "Introduction: Rib fractures are common following blunt trauma. The elderly appear to be more susceptible to rib fractures, and may have worsened outcome following rib fractures. The purpose of this study was to ascertain the extent to which advanced age influences the morbidity and mortality following rib fractures. We also sought to determine the influence of analgesic technique on outcome. Methods: A retrospective cohort study was undertaken. All patients > 65 years with rib fractures admitted to a Level 1 trauma center were identified. A control group of randomly selected patients age 18-64 years with rib fractures admitted during the same time period was also identified. Outcomes which were evaluated included: thoracic complications, ventilator days, ICU length of stay, disposition and mortality. The effect of analgesic techniques on outcome was specifically addressed. Results: There were 277 patients ≥ 65 years admitted with rib fractures over this time period. The control group of 187 patients aged 18-64 years was randomly selected from the total rib fracture population in this age group admitted during this time period. Males accounted for 57{\%} of the elderly patients and 70{\%} of the younger cohort. MVA (60{\%}), falls (19{\%}), and auto-pedestrian (16{\%}) were the principle mechanisms of injury in the elderly, compared to MVA (60{\%}), falls (14{\%}) and crush (8{\%}) in the young. A single rib fracture occurred in 49 (18{\%}) of the elderly and 39 (21{\%}) of the young. The two groups had similar injury distribution by AIS score and overall injury severity, but significantly different outcomes. N Age, yrs # Rib Fxs Chest AIS ISS Pneumonia * Mortality * Elderly 277 74±6 3.6±2.5 2.9 20.7 31{\%} 22{\%} Young 187 39±13 4.0±2.9 3.0 21.4 17{\%} 10{\%} * p<0.01, Chi-square Intubated days (4.5 days for elderly vs. 2.7 days for young), ICU days (6.1 vs. 4.0), and total hospital stay (15.4 vs. 10.7) were also significantly longer in the elderly patients (p<0.05 for all). The use of epidural analgesic in the elderly was associated with and 11{\%} mortality, compared to a 25{\%} mortality without use of epidural (p=0.05). Conclusions: Despite similar injury patterns and injury severity, elderly patients who sustain blunt chest trauma with rib fractures have twice the mortality and thoracic morbidity than younger patients. The use of epidural analgesic appears advantageous in both populations.",
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AU - Arneson, M. A.

AU - Bulger, E. M.

AU - Jurkovich, Gregory

AU - Mock, C.

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Y1 - 1999/1/1

N2 - Introduction: Rib fractures are common following blunt trauma. The elderly appear to be more susceptible to rib fractures, and may have worsened outcome following rib fractures. The purpose of this study was to ascertain the extent to which advanced age influences the morbidity and mortality following rib fractures. We also sought to determine the influence of analgesic technique on outcome. Methods: A retrospective cohort study was undertaken. All patients > 65 years with rib fractures admitted to a Level 1 trauma center were identified. A control group of randomly selected patients age 18-64 years with rib fractures admitted during the same time period was also identified. Outcomes which were evaluated included: thoracic complications, ventilator days, ICU length of stay, disposition and mortality. The effect of analgesic techniques on outcome was specifically addressed. Results: There were 277 patients ≥ 65 years admitted with rib fractures over this time period. The control group of 187 patients aged 18-64 years was randomly selected from the total rib fracture population in this age group admitted during this time period. Males accounted for 57% of the elderly patients and 70% of the younger cohort. MVA (60%), falls (19%), and auto-pedestrian (16%) were the principle mechanisms of injury in the elderly, compared to MVA (60%), falls (14%) and crush (8%) in the young. A single rib fracture occurred in 49 (18%) of the elderly and 39 (21%) of the young. The two groups had similar injury distribution by AIS score and overall injury severity, but significantly different outcomes. N Age, yrs # Rib Fxs Chest AIS ISS Pneumonia * Mortality * Elderly 277 74±6 3.6±2.5 2.9 20.7 31% 22% Young 187 39±13 4.0±2.9 3.0 21.4 17% 10% * p<0.01, Chi-square Intubated days (4.5 days for elderly vs. 2.7 days for young), ICU days (6.1 vs. 4.0), and total hospital stay (15.4 vs. 10.7) were also significantly longer in the elderly patients (p<0.05 for all). The use of epidural analgesic in the elderly was associated with and 11% mortality, compared to a 25% mortality without use of epidural (p=0.05). Conclusions: Despite similar injury patterns and injury severity, elderly patients who sustain blunt chest trauma with rib fractures have twice the mortality and thoracic morbidity than younger patients. The use of epidural analgesic appears advantageous in both populations.

AB - Introduction: Rib fractures are common following blunt trauma. The elderly appear to be more susceptible to rib fractures, and may have worsened outcome following rib fractures. The purpose of this study was to ascertain the extent to which advanced age influences the morbidity and mortality following rib fractures. We also sought to determine the influence of analgesic technique on outcome. Methods: A retrospective cohort study was undertaken. All patients > 65 years with rib fractures admitted to a Level 1 trauma center were identified. A control group of randomly selected patients age 18-64 years with rib fractures admitted during the same time period was also identified. Outcomes which were evaluated included: thoracic complications, ventilator days, ICU length of stay, disposition and mortality. The effect of analgesic techniques on outcome was specifically addressed. Results: There were 277 patients ≥ 65 years admitted with rib fractures over this time period. The control group of 187 patients aged 18-64 years was randomly selected from the total rib fracture population in this age group admitted during this time period. Males accounted for 57% of the elderly patients and 70% of the younger cohort. MVA (60%), falls (19%), and auto-pedestrian (16%) were the principle mechanisms of injury in the elderly, compared to MVA (60%), falls (14%) and crush (8%) in the young. A single rib fracture occurred in 49 (18%) of the elderly and 39 (21%) of the young. The two groups had similar injury distribution by AIS score and overall injury severity, but significantly different outcomes. N Age, yrs # Rib Fxs Chest AIS ISS Pneumonia * Mortality * Elderly 277 74±6 3.6±2.5 2.9 20.7 31% 22% Young 187 39±13 4.0±2.9 3.0 21.4 17% 10% * p<0.01, Chi-square Intubated days (4.5 days for elderly vs. 2.7 days for young), ICU days (6.1 vs. 4.0), and total hospital stay (15.4 vs. 10.7) were also significantly longer in the elderly patients (p<0.05 for all). The use of epidural analgesic in the elderly was associated with and 11% mortality, compared to a 25% mortality without use of epidural (p=0.05). Conclusions: Despite similar injury patterns and injury severity, elderly patients who sustain blunt chest trauma with rib fractures have twice the mortality and thoracic morbidity than younger patients. The use of epidural analgesic appears advantageous in both populations.

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