Blunt chest trauma in the elderly patient: How cardiopulmonary disease affects outcome

Blunt trauma patients with rib fractures have significant risk of morbidity and mortality. The risk of complications increases with age and cardiopulm onary disease. We reviewed our experience at a community hospital Level II trauma center over a 5-year period. A review of the trauma registry reveale d 62 patients over the age of 65 with multiple rib fractures and no associa ted, injuries. Thirty-one patients with cardiopulmonary disease (CPD+) were compared with 31 patients without cardiopulmonary disease (CPD-). Charts w ere reviewed for morbidity, mortality, the need to upgrade level of care (r eadmission to the hospital or intensive care unit), and length of hospitali zation. Complications occurred in 17 of 31 CPD+ patients and in four of 31 CPD- patients (P < 0.001). The only three deaths were in CPD+ patients. Ten CPD+ patients and four CPD- patients required an upgrade in the level of c are (P < 0.05). The CPD+ patients had longer hospitalization than the CPD- patients: 8.5 versus 4.3 days (P : 0.05). We conclude that elderly patients with multiple rib fractures and cardiopulmonary disease are at significant risk for complications that result in readmission to the hospital and inte nsive care unit and prolonged length of hospitalization. Admission to the i ntensive care unit with attention to cardiac and pulmonary status upon tran sfer to the ward is warranted.