Predictors of Dependency in Geriatric Trauma Patients with Rib Fractures: A Population Study

Abstract

The geriatric trauma population is unique. These patients are at risk of being discharged to rehabilitation or a skilled nursing facility, instead of being returned to their homes, placing a significant burden on both the patient families and society. This study evaluated which patient characteristics increase the likelihood of a previously independent geriatric blunt trauma becoming functionally dependent and being discharged to a location other than home. Data were extracted from the National Trauma Data Bank from 2012 to 2014 for blunt trauma patients ≥65 years old, admitted from home, with one or more rib fractures. Primary outcomes were discharge home versus a facility. Subgroup analysis evaluated disposition to acute short-term rehabilitation or subacute rehabilitation or skilled nursing facility. Multivariable analysis was used to calculate probabilities of disposition based on the above variables, controlling for comorbidities. Sixteen thousand six hundred thirty-two patients were included. Only 58 per cent were discharged home. Increased age, ≥4 rib fractures, white race, and female gender were found to increase the risk of discharge to a facility. In addition, patients with chronic renal failure, history of diabetes, obesity, or heart failure were less likely to be discharged home. This study shows that age, gender, race, and the number of rib fractures are statistically significant in predicting which patients are less likely to be discharged home. This reinforces the need for the development of triage and treatment protocols in this higher risk population, to decrease the social and financial burden of these injuries.

Orthogeriatric co-management: differences in outcome between major and minor fractures

“…Upper extremity fractures could result in unsteadiness in walking as the majority of geriatric patients cannot walk sufficiently and safely without aids like wheeled walkers. Additionally, even after rib fractures, a significant loss of self-care capacity and consequences like pneumonia or a predisposition for further falls or readmissions are conceivable [ 23 , 24 ].…”

Evaluation of IL-33R and Galectin-3 as New Biomarkers of Cardiac Damage after Polytrauma—Association with Cardiac Comorbidities and Risk Factors

“…The presence and number of premorbid conditions, anemia, age > 60, pulmonary diseases, cardiac or neurological diseases and ISS were previously determined to be death-predictors in patients with acute blunt chest trauma [ 36 , 37 ]. The cardiac comorbidities not only increase financial burden [ 38 ], but are a significant predictor of mortality in trauma patients [ 39 , 40 ]. Cardiovascular risk factors such as pre-injury warfarin usage, congestive heart failure, and pre-injury beta-blocker use, as well as combinations of these conditions, which result in the greatest mortality rates, increase the chance of trauma death [ 41 , 42 ].…”

Beyond Hip Fractures: Other Fragility Fractures’ Associated Mortality, Functional and Economic Importance: A 2-year-Follow-up.

“…However, more discharges to nursing homes after acute inward treatment of rib fractures are described, being an indicator of a short-term increase of need for care. 6 , 20 …”

“…However, more discharges to nursing homes after acute inward treatment of rib fractures are described, being an indicator of a short-term increase of need for care. 6,20 Using functional results of orthogeriatric treated hip fractures as a reference, recovery of activities of daily living, changes in mobility, and Parker Mobility Score can also be noticed. One year from discharge, Neuerburg et al saw a regain of Barthel Index by 19 points and a proportion of 27.5% of patients that were not able to return to home.…”

“… 1 - 3 Further relevant fragility fractures like periprosthetic and periosteosynthetic femoral, pelvic ring, ankle joint, and rib fractures are not yet well investigated in this context. Although large-scaled index studies are researched for the respective mortality of the previous mentioned injuries, 4 - 6 there are examinations with only few case numbers focusing on other functional and socioeconomic aspects. 7 - 9 Furthermore, studies comparing mortality and functional results in between those relevant fragility fractures are still yet to be found in literature.…”