title: Number of rib fractures thresholds independently predict worse outcomes in older patients with blunt trauma.
abstract: There have been conflicting reports regarding whether the number of rib fractures sustained in blunt trauma is associated independently with worse patient outcomes. We sought to investigate this risk-adjusted relationship among the lesser-studied population of older adults.
  
  
  
  A retrospective review of the National Trauma Data Bank was performed for patients with blunt trauma who were ≥65 years old and had rib fractures between 2009 and 2012 (N = 67,695). Control data were collected for age, sex, injury severity score, injury mechanism, 24 comorbidities, and number of rib fractures. Outcome data included hospital mortality, hospital and intensive care unit durations of stay, duration of mechanical ventilation, and the occurrence of pneumonia. Multiple logistic and linear regression analyses were performed.
  
  
  
  Sustaining ≥5 rib fractures was associated with increased intensive care unit admission (odds ratio: 1.14, P < .001) and hospital duration of stay (relative duration: 105%, P < .001). Sustaining ≥7 rib fractures was associated with an increased incidence of pneumonia (odds ratio: 1.32, P < .001) and intensive care unit duration of stay (relative duration: 122%, P < .001). Sustaining ≥8 rib fractures was associated with increased mortality (odds ratio: 1.51, P < .001) and duration of mechanical ventilation (relative duration: 117%, P < .001).
  
  
  
  In older patients with trauma, sustaining at least 5 rib fractures is a significant predictor of worse outcomes independent of patient characteristics, comorbidities, and trauma burden.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Nikita O
authors.initials: NO
authors.lastname: Shulzhenko
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Tiffany J
authors.initials: TJ
authors.lastname: Zens
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Megan V
authors.initials: MV
authors.lastname: Beems
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Hee Soo
authors.initials: HS
authors.lastname: Jung
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Ann P
authors.initials: AP
authors.lastname: O'Rourke
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Liepert
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: agarwal@surgery.wisc.edu.
authors.forename: Suresh K
authors.initials: SK
authors.lastname: Agarwal
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003131:Combined Modality Therapy; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D053717:Pneumonia, Ventilator-Associated / Q000401:mortality*; D011379:Prognosis; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*