Vital capacity as a predictor of outcome in elderly patients with rib fractures.
BACKGROUND
This study tests the relationships between early bedside vital capacity (VC) measurement and morbidity, mortality, and resource consumption in geriatric blunt chest trauma patients with rib fractures.


METHODS
This was a retrospective study examining all patients > or = 65 years old with rib fractures who had a VC measured within 48 hours of their emergency department evaluation. Outcome variables included pulmonary complications, death from pulmonary complications, hospital length of stay (LOS), intensive care unit length of stay (ICU LOS), and discharge disposition.


RESULTS
Thirty-eight patients met the study criteria. The mean age was 80.2 (+/-7.4) years, the mean number of rib fractures was 3.6 (+/-1.6), and the mean ISS was 6.9 (+/-4.7). VC and the percentage of the predicted vital capacity (pVC) were both inversely correlated with LOS (p = 0.0076 and p = 0.0172, respectively). Linear regression analysis suggested that patients with a VC < 1.4 L or < 55% of their pVC had a LOS > 3 days. Mean VC was 36% higher in patients who were discharged home versus those discharged to an extended care facility (ECF; p = 0.025). There was a trend toward significance when comparing VC to ICU LOS (p = 0.079), but none in predicting pulmonary complications (p = 0.3299). No correlations between VC and mortality can be drawn given the single death in the cohort.


CONCLUSIONS
Bedside VC is a simple measurement which could predict LOS in elderly patients with rib fractures and may identify those patients requiring ECF upon discharge. Further prospective study may highlight the utility of emergency room VC in determining the disposition of these patients.
Bakhos
Charles
C
Department of Surgery, Hospital of Saint Raphael, New Haven, Connecticut 06511, USA. bakhos@sbcglobal.net
O'Connor
Judy
J
Kyriakides
Tassos
T
Abou-Nukta
Fadi
F
Bonadies
John
J
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008171:Lung Diseases / Q000517:prevention & control*; D008297:Male; D012189:Retrospective Studies; D012253:Rib Fractures / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D015599:Trauma Severity Indices; D014797:Vital Capacity; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000628:therapy