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Journal Article

Citation

Harrington DT, Phillips B, Machan J, Zacharias N, Velmahos GC, Rosenblatt MS, Winston E, Patterson L, Desjardins S, Winchell R, Brotman S, Churyla A, Schulz JT, Maung AA, Davis KA. Arch. Surg. (1960) 2010; 145(5): 432-437.

Affiliation

Rhode Island Hospital, Warren Alpert Medical School, Brown University, 593 Eddy St, Ambulatory Patient Care Bldg, Room 443, Providence, RI 02903. dharrington@usasurg.org.

Copyright

(Copyright © 2010, American Medical Association)

DOI

10.1001/archsurg.2010.71

PMID

20479340

Abstract

HYPOTHESIS: We hypothesized that patient factors, injury patterns, and therapeutic interventions influence outcomes among older patients incurring traumatic chest injuries. DESIGN: Patients 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. SETTING: Eight trauma centers. PATIENTS: A total of 1621 patients. Main Outcome Measure Survival. RESULTS: Patient 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. CONCLUSIONS: In 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.


Language: en

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