TY - JOUR
T1 - Factors associated with survival following blunt chest trauma in older patients
T2 - Results from a large regional trauma cooperative
AU - Harrington, David T.
AU - Phillips, Benjamin
AU - Machan, Jason
AU - Zacharias, Nikos
AU - Velmahos, George C.
AU - Rosenblatt, Michael S.
AU - Winston, Eleanor
AU - Patterson, Lisa
AU - Desjardins, Steven
AU - Winchell, Robert
AU - Brotman, Sheldon
AU - Churyla, Andrei
AU - Schulz, John T.
AU - Maung, Adrian A.
AU - Davis, Kimberly A.
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/5
Y1 - 2010/5
N2 - Hypothesis:Wehypothesized that patient factors, injury patterns, and therapeutic interventions influence outcomes among older patients incurring traumatic chest injuries. Design: Patients older than 50 years with at least 1 rib fracture (RF) were retrospectively studied, including institutional data, patient data, clinical interventions, and complications. Univariable and multivariable analyses were performed. Setting: Eight trauma centers. Patients: A total of 1621 patients. Main Outcome Measure: Survival. Results: Patient data collected include the following: age (mean, 70.1 years), number of RFs (mean, 3.7), Abbreviated Injury Scale chest score (mean, 2.7), Injury Severity Score (mean, 11.7), and mortality (overall, 4.6%). On univariable analysis, increased mortality was associated with admission to high-volume trauma centers and level I centers, preexisting coronary artery disease or congestive heart failure, intubation or development of pneumonia, and increasing age, Injury Severity Score, and number of RFs. On multivariable analysis, strongest predictors of mortality were admission to high-volume trauma centers, preexisting congestive heart failure, intubation, and increasing age and Injury Severity Score. Using this predictive model, tracheostomy and patient-controlled analgesia had protective effects on survival. Conclusions: In a large regional trauma cooperative, increasing age and Injury Severity Score were independent predictors of survival among older patients incurring traumatic RFs. Admission to high-volume trauma centers, preexisting congestive heart failure, and intubation added to mortality. Therapies associated with improved survival were patient-controlled analgesia and tracheostomy. Further regional cooperation should allow development of standard care practices for these challenging patients.
AB - Hypothesis:Wehypothesized that patient factors, injury patterns, and therapeutic interventions influence outcomes among older patients incurring traumatic chest injuries. Design: Patients older than 50 years with at least 1 rib fracture (RF) were retrospectively studied, including institutional data, patient data, clinical interventions, and complications. Univariable and multivariable analyses were performed. Setting: Eight trauma centers. Patients: A total of 1621 patients. Main Outcome Measure: Survival. Results: Patient data collected include the following: age (mean, 70.1 years), number of RFs (mean, 3.7), Abbreviated Injury Scale chest score (mean, 2.7), Injury Severity Score (mean, 11.7), and mortality (overall, 4.6%). On univariable analysis, increased mortality was associated with admission to high-volume trauma centers and level I centers, preexisting coronary artery disease or congestive heart failure, intubation or development of pneumonia, and increasing age, Injury Severity Score, and number of RFs. On multivariable analysis, strongest predictors of mortality were admission to high-volume trauma centers, preexisting congestive heart failure, intubation, and increasing age and Injury Severity Score. Using this predictive model, tracheostomy and patient-controlled analgesia had protective effects on survival. Conclusions: In a large regional trauma cooperative, increasing age and Injury Severity Score were independent predictors of survival among older patients incurring traumatic RFs. Admission to high-volume trauma centers, preexisting congestive heart failure, and intubation added to mortality. Therapies associated with improved survival were patient-controlled analgesia and tracheostomy. Further regional cooperation should allow development of standard care practices for these challenging patients.
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U2 - 10.1001/archsurg.2010.71
DO - 10.1001/archsurg.2010.71
M3 - Article
C2 - 20479340
AN - SCOPUS:77952368086
SN - 0004-0010
VL - 145
SP - 432
EP - 437
JO - Archives of Surgery
JF - Archives of Surgery
IS - 5
ER -