Medical background on elderly patients who break ribs due to blunt force trauma, including falls. At least twice the risk of death as compared to younger patients.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732099/
Elderly people who sustain blunt chest trauma have mortality and morbidity rates that are twice the corresponding rates prevalent among the younger population.[5]. Admission characteristics of our study population revealed that falls and vehicle crashes were the largest contributors to trauma admission in this group. Declining vision and hearing, preexisting medical condition, medications and alteration of judgment all probably contributed to some extent to their injuries.[7]
Increased morbidity and mortality in elderly patients with traumatic rib fractures are attributed to several factors such as anatomical difference between young and elderly people (osteoporosis, decreased muscle mass and thinned vertebral bodies), as well as decreased physiological reserve (low cardiopulmonary status and lower immunity),[8,9]. and more likelihood of presence of associated comorbidities. In a study by Morris et al.,[10] preexisting diseases including cirrhosis, coagulopathy, ischemic heart disease, chronic obstructive pulmonary disease and diabetes all significantly increased the morbidity and mortality in elderly trauma patients. Increased number of rib fractures was found to correlate with the morbidity in our patients. This is in agreement with Bulger et al.,[5] who found marked increase in the incidence of pneumonia (31%) and mortality (19%) in elderly patients with 3-4 rib fractures; those with more than 6 rib fractures had 33% mortality and 51% occurrence of pneumonia; and for each additional rib fracture in the elderly, mortality increased by 19% and was associated with 27% increase in the risk of pneumonia. They also found that the number of ventilation days, length of ICU stay and length of hospital stay also increased in those patients. Increase in the number of rib fractures correlated directly with increasing pulmonary morbidity and mortality. Patients sustaining fractures of 6 or more ribs were at significant risk of death from causes unrelated to the rib fractures.[11]
In agreement with our results, Stawicki et al.,[12] found that pulmonary complications were the most common complications in trauma patients with rib fractures. Acute respiratory failure, pleural effusion and pneumonia were more common in elderly patients compared to young patients. Increased age was found to be an independent risk factor for pneumonia in trauma patients.[13].
In the current study, chronic lung disease was found correlated with mortality; this explains the causes of mortality in this study, viz, respiratory failure and pulmonary infection. Preexisting lung problems lead to more frequent pulmonary complications and infection. A recent study demonstrated that elderly patients with multiple-fracture ribs and preexisting cardiopulmonary disease were at high risk of complications, ICU readmission and longer hospitalization.[14]. Pulmonary infection and need of mechanical ventilation were correlated with mortality in the current study. Mechanical ventilation reflects the severity of the injury and predisposes to atalectesis and pneumonia. Pneumonia was found to be an independent predictor of death in old patients with fractured ribs in Bergeron et al. study,[15] which reported 17.9% incidence of pneumonia in the studied patients. Pneumonia occurred more frequently in nonsurvivors (36.7%) compared to survivors (14.3%). Among the preadmission comorbiditities, only diabetes was found to be associated with increased morbidity (P=0.0005). This is in agreement with Barnea et al.,[16] who found that diabetes correlates significantly with morbidity in elderly patients with isolated rib fractures. Diabetic patients are more vulnerable to infections, have a slower healing process and lower immunological status compared to nondiabetic patients.