Background: We sought to ascertain the extent to which advanced age influen
ces the morbidity and mortality after rib fractures (fxs), to define the re
lationship between number of rib fractures and morbidity and mortality, and
to evaluate the influence of analgesic technique on outcome.
Methods: A retrospective cohort study involving all 277 patients greater th
an or equal to 65 years old with rib fxs admitted to a Level I trauma cente
r over 10 years was undertaken. The control group consisted of 187 randomly
selected patients, 18 to 64 years old, with rib fxs admitted over the same
time period. Outcomes included pulmonary complications, number of ventilat
or days, length of intensive care unit and hospital stay (LOS), disposition
, and mortality. The specific analgesic technique used was also examined,
Results: The two groups had similar mean number of rib fxs (3.6 elderly vs.
4.0 young), mean chest Abbreviated injury Scores (3.0 vs, 3,0), and mean I
njury Severity Score (20.7 vs, 21,4), However, mean number of ventilator da
ys (4.3 vs. 3,1) intensive care unit days (6.1 vs. 4,0), and LOS (15.4 vs,
10.7 days) were longer for the elderly patients, Pneumonia occurred in 31%
of elderly versus 17% of young (p < 0.01) and mortality was 22% for the eld
erly, versus 10% for the young (p < 0.01). Mortality and pneumonia rates in
creased as the number of rib fxs increased with and odds ratio for death of
1.19 and for pneumonia of 1.16 per each additional rib fracture (p < 0.001
). The use of epidural analgesia in the elderly (LOS >2 days) was associate
d with a 10% mortality versus 16% without the use of an epidural (p = 0,28)
, In the younger group (LOS > 2 days), mortality with and without the use o
f an epidural was 0% and 5%, respectively.
Conclusion: Elderly patients who sustain blunt chest trauma with rib fxs ha
ve twice the mortality and thoracic morbidity of younger patients with simi
lar injuries, For each additional rib fracture in the elderly mortality inc
reases by 19% and the risk of pneumonia by 27%. As the number of rib fractu
res increases, there is a significant increase in morbidity and mortality i
n both groups, but with different patterns For each group. Further prospect
ive study Is needed to determine the utility of epidural analgesia in this
population.