Cooper Emma V, Hughes Ian, Campbell Don, Mahoney Adam, Balogh Zsolt J, Marasco Silvana F, Patel Bhavik
Bond University, Gold Coast University Hospital, 1, Hospital Boulevard, Queensland, Australia.
Royal Hobart Hospital, Hobart, TAS, Australia.
Eur J Trauma Emerg Surg. 2025 Aug 28;51(1):281. doi: 10.1007/s00068-025-02962-z.
Rib fractures in the elderly can lead to significant morbidity and mortality. Management is generally conservative due to the perceived risks related to frailty and co-morbidities. The primary aim of this exploratory study was to describe the demographics and outcomes of traumatic rib fractures in older Australians admitted to major trauma centres. The secondary aim was to describe the management strategies employed, the involvement of specialist pain services, involvement of geriatric services, availability of surgical options and evaluate any variability in management at participating centres.
Multicentre, retrospective cohort. Patients ≥ 70 years with multiple rib fractures admitted to Australian Level 1 trauma centres during 2019. Outcomes included: demographics and mechanisms of injury, treatment and management practices (ICU admission, mechanical ventilation, analgesia mode and pain service use, surgery, geriatrics involvement), and patients' clinical outcomes.
491 patients were included from six centres. 282 (57.4%) were male, 445 (90.6%) from home, 218 (44.4%) fell from < 1 m, with a median 5.5 fractures, and Injury Severity Score (ISS) 13. Rates of low energy fall as mechanism of injury varied by site (range 16-62%, P = 0.001), the number of fractured ribs (P = 0.45) and ISS (P = 0.1) were consistent across sites. 208 (42.4%; range 19-55%, P < 0.001) were admitted to ICU with 53 (10.8%; range 7-29%, P = 0.002) ventilated. Acute Pain Services were utilised for 340 (69.4%; range 60-88%, P = 0.07) patients, 132 (27.0%; range 19-50%, P < 0.001) had regional anaesthesia and 167 (67%; range 4-79%. P < 0.001) geriatric input. Surgical rib fixation occurred in 14 (2.9%; range 0-9.2%). Median hospital LOS was 8.1 days (IQR 4.2, 13.4) with 234 (47.7%) returning home. In-hospital mortality was 42 (8.6%). 181 patients (36.9%; range 24-53%, P = 0.02) had at least one complication.
There is significant variability in the demographics of elderly patients presenting with rib fractures and discrepancy in management of these patients at Australia's Level 1 trauma centres. This study presents an opportunity to further investigate the presence of a causal relationship, optimise treatment strategies for best clinical outcomes and future prospective and interventional studies in this high-risk population.
老年人肋骨骨折可导致严重的发病和死亡。由于认识到与身体虚弱和合并症相关的风险，治疗通常较为保守。这项探索性研究的主要目的是描述入住主要创伤中心的澳大利亚老年患者创伤性肋骨骨折的人口统计学特征和结局。次要目的是描述所采用的管理策略、专科疼痛服务的参与情况、老年服务的参与情况、手术选择的可用性，并评估参与中心管理的任何变异性。
多中心回顾性队列研究。2019年期间入住澳大利亚一级创伤中心的年龄≥70岁的多根肋骨骨折患者。结局包括：人口统计学特征和损伤机制、治疗和管理实践（入住重症监护病房、机械通气、镇痛方式和疼痛服务使用情况、手术、老年医学参与情况）以及患者的临床结局。
来自六个中心的491例患者被纳入研究。男性282例（57.4%），445例（90.6%）来自家中，218例（44.4%）从<1米处跌落，中位骨折数为5.5根，损伤严重程度评分（ISS）为13分。低能量跌倒作为损伤机制的发生率因部位而异（范围为16 - 62%，P = 0.001），骨折肋骨数量（P = 0.45）和ISS（P = 0.1）在各部位一致。208例（42.4%；范围为19 - 55%，P < 0.001）入住重症监护病房，53例（10.8%；范围为7 - 29%，P = 0.002）接受机械通气。340例（69.4%；范围为60 - 88%，P = 0.07）患者使用了急性疼痛服务，132例（27.0%；范围为19 - 50%，P < 0.001）接受了区域麻醉，167例（67%；范围为4 - 79%，P < 0.001）有老年医学介入。14例（2.9%；范围为0 - 9.2%）进行了手术肋骨固定。中位住院时间为8.1天（四分位间距4.2，13.4），234例（47.7%）回家。住院死亡率为42例（8.6%）。181例患者（36.9%；范围为24 - 53%，P = 0.02）至少有一项并发症。
出现肋骨骨折的老年患者的人口统计学特征存在显著差异，澳大利亚一级创伤中心对这些患者的管理也存在差异。本研究提供了一个机会，可进一步调查因果关系的存在，优化治疗策略以获得最佳临床结局，并对这一高危人群进行未来的前瞻性和干预性研究。
