Analysis of Injury Patterns and Outcomes of Blunt Thoracic Trauma in Elderly Patients

Abstract

In the elderly population, trauma is a leading cause of utilization of healthcare, institutionalization, disability, and mortality. In this study, we will assess the injury patterns and the factors associated with the outcomes of blunt thoracic trauma in elderly individuals. Methods This prospective observational study was conducted in the Department of Thoracic Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from September 2019 to April 2020. The study included patients of both genders aged 60 years and above with blunt thoracic trauma. Patients with concomitant neurological injuries and penetrating trauma to the chest were excluded. Results There were a total of 80 patients in this study; majority were males (n = 66 [82.5%]). The mean age was 70.18 ± 8.3 years. Road traffic accident was the most common mode of injury (n = 45 [56.3%]) followed by fall (n = 32 [40%]). Hemothorax and hemopneumothorax were the most common primary diagnosis. Rib fractures were encountered in 72 (90%) patients. Mortality rate was 21.3% (n = 17). Factors significantly related to mortality were age ≥ 80 years (p = 0.00), tension pneumothorax (p = 0.036), pre-existing cardiopulmonary disease (p = 0.032), blood loss ≥ 500 mL (p = 0.004), flail chest (p = 0.018), and chest trauma score ≥ 5 (p = 0.001). Mean hospital stay in our study was 5.3 ± 3.4 days. Factors lengthening hospital stay by more than five days included lung contusion (p = 0.02), more than two rib fractures (p = 0.004), hemopneumothorax (p = 0.026), pneumonia (p = 0.003), acute respiratory distress syndrome (p = 0.003), and flail chest (p = 0.013). Conclusions Elderly patients with blunt thoracic trauma have higher mortality. Proactive evaluation of injuries using the chest trauma score in the elderly population helps in recognizing patients at high risk of mortality and helps in the timely management to prevent adverse outcomes.

Health care utilization outcomes in patients with blunt chest wall trauma following discharge from the emergency department: A retrospective, observational data-linkage study

“…Chronic lung disease has been reported previously as a predictor of poor in-hospital patient outcomes in patients with blunt chest wall trauma 8,33–35 . In this study, COPD was also a predictor of increased health care resource utilization in patients discharged directly home from the ED.…”

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

“…Of these, 19 studies demonstrated a higher risk of mortality in patients aged 65 years or more when compared with patients aged less than 65 years 7 13–16 30–43. Other studies demonstrated that increased risk of mortality occurred in patients aged 50 years or more,17 55 years or more,44 45 60 years or more,46–50 70 years or more,51 80 years or more,52 and 90 years or more 53. A number of studies demonstrated an increasing risk of mortality per additional year of age5 54–56 and others with an additional decade 2 14 57.…”

“…There was however substantial heterogeneity across the studies with the independent variable investigated ranging from Elixhauser Comorbidity Count, Charlson Comorbidity Score, cardiopulmonary disease, cardiac disease and others. Eight studies investigated the risk factor cardiopulmonary disease with six reporting it as a significant risk factor2 52 53 56 76 77 and two reporting no significance 18 72. Congestive heart failure was a significant risk factor in six studies 2 17 33 53 56 72.…”

Unplanned Readmissions to the Intensive Care Unit Among Geriatric Trauma Patients

“…Consequently, thoracic trauma associated with lung contusion, more than two rib factors, hemopneumothorax, pneumonia, acute respiratory distress syndrome, and flail chest have contributed to lengthening geriatric patients' stay by more than 5 days duration. 18 Interestingly, thoracic trauma with AIS ≥3 in patients aged ≥65 years had .75 odds of mortality in our study. Over ¼ of the patients or 28% who had ICUBB in our cohort suffered head trauma.…”