Eur J Trauma Emerg Surg. 2019 Jul 19;Epub ahead of print

# Predictors of mortality in patients with rib fractures.

Marini C, Petrone P, Soto-Sánchez A, García-Santos E, Stoller C, Verde J

BACKGROUND: The aim of this study was to identify risk factors for morbidity and mortality in patients with rib fractures with focus on identifying a more exact age-dependent cut-off for increased morbidity and mortality.

METHODS: Retrospective study of patients 16 years or older with rib fractures from blunt trauma.

EXCLUSION CRITERIA: patients undergoing rib plating. Initial chest X-ray and Computed Tomography (CT) scans were re-read for the number of rib fractures (NRF) and presence of pulmonary contusion (PC). Data included demographics, mechanism of injury (MOI), NRF, associated injuries, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Geriatric Trauma Outcome Score (GTOS), presence of pneumothorax, hemothorax, hemo-pneumothorax, PC, Adult Respiratory Distress Syndrome (ARDS), pulmonary complications (ventilator-associated pneumonia, nosocomial pneumonia), and mortality. PC was quantified from CT scans with Mimics. Continuous data were analyzed using Student's t test. Variables significantly different by univariate analysis were analyzed by logistic regression analysis.

RESULTS: The study group consisted of 1188 adult trauma patients admitted during a 2-year period; 800 males and 388 females, with a mean age of 54 ± 21. MOI: MVC, 735 (61.8%); falls, 364 (30.6%); other: 89. Mean NRF, 4 ± 2; GCS, GTOS, and ISS, 15 (15-15), 101 (82-124), and 19 ± 9, respectively. Incidence of PC was 329 (27.7%); PTX, HTX, and HTX/PTX, 264 (20.2%), 57 (4.8%), and 147 (12.4%). Flail chest, in 17 (1.4%); 321 required mechanical ventilation. Age, GCS, male gender, and ISS but not NRF and/or PC were predictive of mortality.

CONCLUSIONS: Increased mortality in patients with rib fractures starts at 65 years of age without a further increase until age ≥ 80. NRF does not predict increased mortality independent of age. Severe TBI is the most common cause of death in patients 16-75 years, as opposed to respiratory complications in patients 80 years-old or greater.