• David T Harrington, Benjamin Phillips, Jason Machan, Nikos Zacharias, George C Velmahos, Michael S Rosenblatt, Eleanor Winston, Lisa Patterson, Steven Desjardins, Robert Winchell, Sheldon Brotman, Andrei Churyla, John T Schulz, Adrian A Maung, Kimberly A Davis, and Research Consortium of New England Centers for Trauma (ReCONECT).
• Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA. dharrington@usasurg.org
• Arch Surg. 2010 May 1;145(5):432-7.

HypothesisWe hypothesized that patient factors, injury patterns, and therapeutic interventions influence outcomes among older patients incurring traumatic chest injuries.DesignPatients 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.SettingEight trauma centers.PatientsA total of 1621 patients.Main Outcome MeasureSurvival.ResultsPatient 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.ConclusionsIn 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.

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