Factors associated with survival following blunt chest trauma in older patients: results from a large regional trauma cooperative.
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.
Harrington
David T
DT
Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA. dharrington@usasurg.org
Phillips
Benjamin
B
Machan
Jason
J
Zacharias
Nikos
N
Velmahos
George C
GC
Rosenblatt
Michael S
MS
Winston
Eleanor
E
Patterson
Lisa
L
Desjardins
Steven
S
Winchell
Robert
R
Brotman
Sheldon
S
Churyla
Andrei
A
Schulz
John T
JT
Maung
Adrian A
AA
Davis
Kimberly A
KA
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*