Older trauma patients with isolated chest injuries have low rates of complications

Introduction: The number of older adults hospitalised for injury is growing rapidly. The population -adjusted incidence of isolated thoracic injuries in older adults is also growing. While some older adults are at high risk of post-traumatic complications, not all older adults will need treatment in a major trauma service (MTS). The aim of this study was to characterise older patients with isolated chest in-juries, determine the rates of post-traumatic complications, including respiratory failure and pneumonia, and the factors associated with the risk of developing these complications.Patients and Methods: This was a retrospective review of patients aged 65 years and over with isolated chest trauma, from January 2007 to June 2017, using data from the Victorian State Trauma Registry. Pa-tient characteristics and rates of complications were compared between patients with 1. isolated rib frac-tures, and 2. complex chest injury. Multivariable logistic regression was used to identify predictors of respiratory failure, and pneumonia.Results: The study population comprised 5401 patients aged 65 years or more, with isolated chest in-juries. Two-thirds (65%) of all patients had isolated rib fractures, and 58% of patients ( n = 3156) were directly admitted to a non-major trauma centre. Complications were uncommon, with 5.45% of all pa-tients ( n = 295) having pneumonia and 3.2% ( n = 175) having respiratory failure. Factors associated with increased risk of pneumonia and respiratory failure included advancing age, smoking, chronic obstruc-tive pulmonary disease, congestive heart failure, and more severe and complex chest injury. The adjusted odds of complications were lowest amongst patients not classified as major trauma and receiving defini-tive treatment in non-MTS.Discussion: Our findings suggest that rates of complications in older patients with isolated chest trauma in this study were low, and that there is a large group of patients with isolated, uncomplicated rib frac-tures, who may not need to be treated in a major trauma centre. Further work should be undertaken to appropriately risk stratify and manage older adults with isolated chest trauma. (c) 2022 Published by Elsevier Ltd.

Automated summary

The number of older adults hospitalised for injury and the incidence of isolated thoracic injuries in older adults are increasing. The study found that rates of complications in older patients with isolated chest trauma are low, and most patients do not need treatment in a major trauma service.