Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Eur J Trauma Emerg Surg. 2019 Aug;45(4):575-583. doi: 10.1007/s00068-018-0969-9. Epub 2018 Jun 15.
High rates of pneumonia and death have been reported among elderly patients with rib fractures. This study aims to identify patterns of injury and risk factors for pneumonia and death in elderly patients with rib fractures.
A retrospective multicenter observational study was performed using data registered in the national trauma registry between 2008 and 2015 in the South West Netherlands Trauma region. Data regarding demographics, mechanism of injury, pulmonary and cardiovascular history, pattern of extra-thoracic and intrathoracic injuries, ICU admission, length of stay, and morbidity and mortality following admission were collected.
Eight hundred eighty-four patients were included. Median age was 76 years (P-P 70-83). 235 patients (26.6%) were 81 years or older. Moderate or worse extra-thoracic injuries were present in 456 patients (51.6%), of whom 146 (16.6%) had severe head injuries and 45 (5.1%) severe spinal injuries. Median ISS was 9 (P-P 5-18). The rate of pneumonia was 10% (n = 84). Ten percent of patients (n = 88) died. Risk factors for in-hospital mortality included age (OR 3.4; p = 0.003), presence of COPD (OR 1.3; p = 0.01), presence of cardiac disease (OR 2.6; p = 0.003), severe or worse head (OR 3.5; p < 0.001), abdominal (OR 6.8; p = 0.004) and spinal injury (OR 4.6; p = 0.011) by AIS, number of rib fractures (OR 2.6; p = 0.03), and need for chest tube drainage (OR 2.1; p = 0.021).
Pneumonia and death occur in about 10% of elderly patients with rib fractures. Apart from the severity of thoracic injuries, the presence and severity of extra-thoracic injuries and cardiopulmonary comorbidities are associated with poor outcome.
有报道称，老年肋骨骨折患者的肺炎和死亡率较高。本研究旨在确定老年肋骨骨折患者肺炎和死亡的模式及相关风险因素。
本研究采用回顾性多中心观察性研究方法，使用 2008 年至 2015 年期间荷兰西南部创伤地区国家创伤登记处登记的数据。收集的资料包括人口统计学、损伤机制、肺部和心血管病史、胸外和胸内损伤模式、重症监护病房收治、住院时间以及住院后的发病率和死亡率。
共纳入 884 例患者，中位年龄为 76 岁（P-P 70-83）。235 例（26.6%）患者年龄在 81 岁或以上。456 例（51.6%）患者存在中度或更严重的胸外损伤，其中 146 例（16.6%）患者有严重的头部损伤，45 例（5.1%）患者有严重的脊柱损伤。ISS 中位数为 9（P-P 5-18）。肺炎发生率为 10%（n=84）。10%的患者（n=88）死亡。院内死亡的风险因素包括年龄（OR 3.4；p=0.003）、COPD 病史（OR 1.3；p=0.01）、心脏疾病病史（OR 2.6；p=0.003）、严重或更严重的头部（OR 3.5；p<0.001）、腹部（OR 6.8；p=0.004）和脊柱损伤（OR 4.6；p=0.011）、肋骨骨折数量（OR 2.6；p=0.03）和需要胸腔引流管（OR 2.1；p=0.021）。
约 10%的老年肋骨骨折患者发生肺炎和死亡。除了胸部损伤的严重程度外，胸外损伤和心肺合并症的存在和严重程度与不良预后相关。
