Factors associated with survival following blunt chest trauma in older patients: Results from a large regional trauma cooperative

David T. Harrington, Benjamin Phillips, Jason Machan, Nikos Zacharias, George C. Velmahos, Michael S. Rosenblatt, Eleanor Winston, Lisa Patterson, Steven Desjardins, Robert Winchell, Sheldon Brotman, Andrei Churyla, John T. Schulz, Adrian A. Maung, Kimberly A. Davis

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)432-437
Number of pages6
JournalArchives of Surgery
Volume145
Issue number5
DOIs
StatePublished - May 1 2010

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Thorax
Survival
Wounds and Injuries
Injury Severity Score
Trauma Centers
Intubation
Patient-Controlled Analgesia
Heart Failure
Mortality
Tracheostomy
Abbreviated Injury Scale
Rib Fractures
Thoracic Injuries
Standard of Care
Coronary Artery Disease
Pneumonia
Outcome Assessment (Health Care)
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Harrington, D. T., Phillips, B., Machan, J., Zacharias, N., Velmahos, G. C., Rosenblatt, M. S., ... Davis, K. A. (2010). Factors associated with survival following blunt chest trauma in older patients: Results from a large regional trauma cooperative. Archives of Surgery, 145(5), 432-437. https://doi.org/10.1001/archsurg.2010.71
Harrington, David T. ; Phillips, Benjamin ; Machan, Jason ; Zacharias, Nikos ; Velmahos, George C. ; Rosenblatt, Michael S. ; Winston, Eleanor ; Patterson, Lisa ; Desjardins, Steven ; Winchell, Robert ; Brotman, Sheldon ; Churyla, Andrei ; Schulz, John T. ; Maung, Adrian A. ; Davis, Kimberly A. / Factors associated with survival following blunt chest trauma in older patients : Results from a large regional trauma cooperative. In: Archives of Surgery. 2010 ; Vol. 145, No. 5. pp. 432-437.
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abstract = "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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Harrington, DT, Phillips, B, Machan, J, Zacharias, N, Velmahos, GC, Rosenblatt, MS, Winston, E, Patterson, L, Desjardins, S, Winchell, R, Brotman, S, Churyla, A, Schulz, JT, Maung, AA & Davis, KA 2010, 'Factors associated with survival following blunt chest trauma in older patients: Results from a large regional trauma cooperative', Archives of Surgery, vol. 145, no. 5, pp. 432-437. https://doi.org/10.1001/archsurg.2010.71

Factors associated with survival following blunt chest trauma in older patients : Results from a large regional trauma cooperative. / Harrington, David T.; Phillips, Benjamin; Machan, Jason; Zacharias, Nikos; Velmahos, George C.; Rosenblatt, Michael S.; Winston, Eleanor; Patterson, Lisa; Desjardins, Steven; Winchell, Robert; Brotman, Sheldon; Churyla, Andrei; Schulz, John T.; Maung, Adrian A.; Davis, Kimberly A.

In: Archives of Surgery, Vol. 145, No. 5, 01.05.2010, p. 432-437.

Research output: Contribution to journalArticle

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.

PY - 2010/5/1

Y1 - 2010/5/1

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

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VL - 145

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