Rib Fracture Injury Guidelines for Patients Over the Age of 65: Should These Patients Routinely Be Admitted to the Intensive Care Unit?

INTRODUCTION

The 2022 Eastern Association for the Surgery of Trauma guidelines state there is insufficient data to recommend intensive care unit (ICU) versus non-ICU admission for patients older than 65 y with > 3 rib fractures. This study aims to identify factors leading to worse outcomes to ultimately create a new admission triage algorithm for older adult patients with rib fractures.

METHODS

Patients aged 65 y or older with ≥ 3 rib fractures were identified between 2016 and 2023 using our institutional trauma database. Patient demographics, comorbidities, and injury characteristics were collected. The primary outcome was predictors of a composite negative outcome (mortality, pneumonia, and readmission to ICU).

RESULTS

A total of 495 patients were included, with 340 patients admitted to the ICU and 155 patients admitted to the floor. Multivariable analysis demonstrated that frailty (odds ratio [OR]: 11.82, P < 0.001), ≥ 5 rib fractures (OR: 2.64, P = 0.04), chest tube placement (OR: 3.31, P = 0.04), and regional nerve block (OR: 4.66, P = 0.001) were all associated with worse outcomes.

CONCLUSIONS

Patients with blunt thoracic trauma who are ≥ 65 y, frail, and have ≥ 5 rib fractures may benefit from ICU admission. Future studies will assess the validity of a new proposed admission triage algorithm.