Highlights
-
- •Older patients with isolated chest trauma have low rates of complication.
- •The majority of patients are treated in non-major trauma centres.
- •Patients with isolated rib fractures, and those treated in non-major trauma centres have the lowest rates of complications.
- •There is a large group of patients with isolated rib fractures, who may not need to be treated in a major trauma centre.
- •
Abstract
Introduction
The number of older adults hospitalised for injury is growing rapidly. The population-adjusted
incidence of isolated thoracic injuries in older adults is also growing. While some
older adults are at high risk of post-traumatic complications, not all older adults
will need treatment in a major trauma service (MTS). The aim of this study was to
characterise older patients with isolated chest injuries, determine the rates of post-traumatic
complications, including respiratory failure and pneumonia, and the factors associated
with the risk of developing these complications.
Patients and Methods
This was a retrospective review of patients aged 65 years and over with isolated chest
trauma, from January 2007 to June 2017, using data from the Victorian State Trauma
Registry. Patient characteristics and rates of complications were compared between
patients with 1. isolated rib fractures, and 2. complex chest injury. Multivariable
logistic regression was used to identify predictors of respiratory failure, and pneumonia.
Results
The study population comprised 5401 patients aged 65 years or more, with isolated
chest injuries. Two-thirds (65%) of all patients had isolated rib fractures, and 58%
of patients (n = 3156) were directly admitted to a non-major trauma centre. Complications were uncommon,
with 5.45% of all patients (n = 295) having pneumonia and 3.2% (n = 175) having respiratory failure. Factors associated with increased risk of pneumonia
and respiratory failure included advancing age, smoking, chronic obstructive pulmonary
disease, congestive heart failure, and more severe and complex chest injury. The adjusted
odds of complications were lowest amongst patients not classified as major trauma
and receiving definitive treatment in non-MTS.
Discussion
Our findings suggest that rates of complications in older patients with isolated chest
trauma in this study were low, and that there is a large group of patients with isolated,
uncomplicated rib fractures, who may not need to be treated in a major trauma centre.
Further work should be undertaken to appropriately risk stratify and manage older
adults with isolated chest trauma.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The changing face of major trauma in the UK.Emerg Med J. 2015; 32: 911-915
- Age-related trends in severe injury hospitalization in Canada.J Trauma Acute Care Surg. 2014; 77: 608-613
- Major trauma in older persons.BJS Open. 2018; 2: 310-318
- Department of, E. and D. Social affairs. population, world population ageing: 2017 highlights.UN, 2017
- Severe and multiple trauma in older patients; incidence and mortality.Injury. 2009; 40: 362-367
- Major trauma in older persons.BJS Open. 2018;
- Factors affecting mortality in older trauma patients – a systematic review and meta-analysis.Injury. 2016; 47: 1170-1183
- Blunt chest trauma in the elderly: an expert practice review.Emerg Med J. 2020; 37: 73-78
- Research network. Major trauma in older people.Trauma Audit and Research Network, Salford UK2017
- Ageing population has changed the nature of major thoracic injury.Emerg Med J. 2019; 36: 340-345
- Factors associated with survival following blunt chest trauma in older patients: results from a large regional trauma cooperative.Arch Surg. 2010; 145: 432-437
- Decreased risk of delirium with use of regional analgesia in geriatric trauma patients with multiple rib fractures.Ann Surg. 2018; 268: 534-540
- Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study.Eur J Trauma Emerg Surg. 2019; 45: 575-583
- Comparison of geriatric trauma outcomes when admitted to a medical or surgical service after a fall.J Surg Res. 2019; 233: 391-396
- Cohort study on the prevalence and risk factors for delayed pulmonary complications in adults following minor blunt thoracic trauma.Can J Emerg Med. 2014; 16: 136-143
- Number of rib fractures thresholds independently predict worse outcomes in older patients with blunt trauma.Surgery. 2017; 161: 1083-1089
- Pulmonary contusions in the elderly after blunt trauma: incidence and outcomes.J Surg Res. 2018; 230: 110-116
- Victorian state trauma system.2020 ([cited 2020 17th November])
- International statistical classification of diseases and related health problems: alphabetical index. 3. World Health Organization, 2004
- Risk factors for adverse outcomes in older adults with blunt chest trauma: a systematic review.Can J Emerg Med. 2018; 20: 614-622
- Abbreviated injury scale 2005: update 2008.Russ Reeder, 2008 (200)
- Applied logistic regression. 398. John Wiley & Sons, 2013
- Half-a-dozen ribs: the breakpoint for mortality.Surgery. 2005; 138: 717-725
- Factors associated with complications in older adults with isolated blunt chest trauma.West J Emerg Med. 2009; 10: 79
- Admission of elderly blunt thoracic trauma patients directly to the intensive care unit improves outcomes.J Surg Res. 2017; 219: 334-340
- Western trauma association critical decisions in trauma: management of rib fractures.J Trauma Acute Care Surg. 2017; 82: 200-203
- Older adults with isolated rib fractures do not require routine intensive care unit admission.J Surg Res. 2020; 245: 492-499
- Effect of systematic intensive care unit triage on long-term mortality among critically ill elderly patients in France: a randomized clinical trial.JAMA. 2017; 318: 1450-1459
Article Info
Publication History
Published online: October 06, 2022
Accepted:
September 25,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd.
