title: Factors associated with survival following blunt chest trauma in older patients: results from a large regional trauma cooperative.
abstract: OBJECTIVE
  We hypothesized that patient factors, injury patterns, and therapeutic interventions influence outcomes among older patients incurring traumatic chest injuries.
  
  
  METHODS
  Patients older than 50 years with at least 1 rib fracture (RF) were retrospectively studied, including institutional data, patient data, clinical interventions, and complications. Univariable and multivariable analyses were performed.
  
  
  METHODS
  Eight trauma centers.
  
  
  METHODS
  A total of 1621 patients.
  
  
  METHODS
  Survival.
  
  
  RESULTS
  Patient data collected include the following: age (mean, 70.1 years), number of RFs (mean, 3.7), Abbreviated Injury Scale chest score (mean, 2.7), Injury Severity Score (mean, 11.7), and mortality (overall, 4.6%). On univariable analysis, increased mortality was associated with admission to high-volume trauma centers and level I centers, preexisting coronary artery disease or congestive heart failure, intubation or development of pneumonia, and increasing age, Injury Severity Score, and number of RFs. On multivariable analysis, strongest predictors of mortality were admission to high-volume trauma centers, preexisting congestive heart failure, intubation, and increasing age and Injury Severity Score. Using this predictive model, tracheostomy and patient-controlled analgesia had protective effects on survival.
  
  
  CONCLUSIONS
  In a large regional trauma cooperative, increasing age and Injury Severity Score were independent predictors of survival among older patients incurring traumatic RFs. Admission to high-volume trauma centers, preexisting congestive heart failure, and intubation added to mortality. Therapies associated with improved survival were patient-controlled analgesia and tracheostomy. Further regional cooperation should allow development of standard care practices for these challenging patients.
authors.affiliation: Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA. dharrington@usasurg.org
authors.forename: David T
authors.initials: DT
authors.lastname: Harrington
authors.forename: Benjamin
authors.initials: B
authors.lastname: Phillips
authors.forename: Jason
authors.initials: J
authors.lastname: Machan
authors.forename: Nikos
authors.initials: N
authors.lastname: Zacharias
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.forename: Michael S
authors.initials: MS
authors.lastname: Rosenblatt
authors.forename: Eleanor
authors.initials: E
authors.lastname: Winston
authors.forename: Lisa
authors.initials: L
authors.lastname: Patterson
authors.forename: Steven
authors.initials: S
authors.lastname: Desjardins
authors.forename: Robert
authors.initials: R
authors.lastname: Winchell
authors.forename: Sheldon
authors.initials: S
authors.lastname: Brotman
authors.forename: Andrei
authors.initials: A
authors.lastname: Churyla
authors.forename: John T
authors.initials: JT
authors.lastname: Schulz
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Maung
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Davis
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012253:Rib Fractures / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality* / Q000628:therapy*