Demographics, treatment, and outcomes of rib fractures in older adults: a retrospective multi-institutional study.

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.