Age-adjusted outcomes in traumatic flail chest injuries in the elderly

Severe chest trauma does not independently predict poor outcome in elderly patients. We chose a specific injury, flail chest, to determine whether age factored into outcome of these patients. A retrospective chart review of a ll trauma admissions to our Level I trauma center between January 1994 and January 1998 sustaining flail chest was undertaken. Sixty-eight patients we re identified, but ten patients were excluded because of death on arrival. Fifty-eight patients were included in the study and separated into groups. The first group comprised those under the age of 55 (n = 32) and the second comprised those over age 55 (n = 26). Parameters evaluated were age, Injur y Severity Score (ISS), neurologic injury, the need for mechanical ventilat ion, need for tracheostomy, length of stay, and death. Statistical analysis was performed with Wilcoxon t test, chi(2), and logistic regression where appropriate. A 95 per cent confidence interval was sought as determinant of significance. Of the 58 surviving patients analyzed there was no significa nt difference between the groups regarding ISS, length of stay, days on the ventilator, head injury, tracheostomy, or development of pneumonia or adul t respiratory distress syndrome. The likelihood of death was shown to incre ase by 132 per cent for every 10 years starting at the second decade and co ntinuing to the eighth decade of life. The likelihood of death also increas ed by 30 per cent for each unit increase in ISS. The likelihood of death de creased by 23 per cent for every day survived in the hospital. Blunt chest trauma directly impacts respiratory mechanics. Elderly patients are more li kely to have comorbid conditions and less likely to tolerate traumatic resp iratory compromise. Age (and its effects on the body) is the strongest pred ictor of outcome with flail chest and is associated with an increased morta lity (P less than or equal to 0.05).