Schmoekel N, Berguson J, Stassinopoulos J, Karamanos E, Patton J, Johnson J. Rib fractures in the elderly: physiology trumps anatomy.. Trauma Surg Acute Care Open 2019; 4(1):000257-000257.
Trauma Surg Acute Care Open
Introduction: Rib fractures in elderly patients are associated with increased morbidity and mortality. Predicting which patients are at risk for complications is an area of debate. Current models use anatomic, physiologic or laboratory parameters in isolation to answer this question. The 'RibScore' is an anatomic model that assesses fracture severity. Given that frailty is a major driver of adverse outcomes in the elderly, we hypothesize that the combined analysis of fracture severity, physiologic reserve and current pulmonary function are better predictors of respiratory compromise in this population.
Methods: This is a retrospective chart review of 263 trauma patients age ≥55 from January 2014 to June 2017. Criteria included blunt mechanism and ≥ 1 rib fracture identified by CT. Variables indicating adverse pulmonary outcomes were defined by: pneumonia, respiratory failure and tracheostomy. Three models were assessed: (1) RibScore, (2) Modified Frailty Index (mFI) and (3) initial partial pressure of carbondioxide (PaCO
Results: A total of 263 patients met inclusion criteria. 13% developed pulmonary complications. Increased RibScore, mFI and PaCO
Discussion: The RibScore maintains discriminative ability in the elderly. However, models based on mFI and PaCO
Level of evidence: Prognostic Study, Level III.