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
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Article info
Publication history
Published online: October 06, 2022
Accepted:
September 25,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd.
