Isolated Rib Fractures in Elderly Falls: Not As Deadly As We Think.

Abstract

Rib fractures in elderly patients have been associated with high morbidity and mortality; however, many of these patients had substantial mechanisms of injury, which may have contributed to these high rates. The purpose of this study was to determine the morbidity and mortality of elderly patients with isolated rib fractures who fell from standing. A single-institution retrospective study was conducted in a Level I trauma center using the trauma registry and a separate elderly fall from standing database. Admitted patients 65 years or older who presented with rib fractures after a fall from January 2013 to June 2017 were included. Patients with a nonthoracic Abbreviated Injury Scale score greater than 2 were excluded from the study. Of 129 patients with isolated rib fracture, 94% (n = 121) had comorbidities and 71% (n = 92) had two or more comorbidities. Almost half (41.9%; n = 54) were taking antiplatelet and anticoagulant medications, 78.3% (n = 101) were caused by a mechanical fall, and 7% (n = 9) were caused by syncope. Data showed 72.9% (n = 94) had three or more rib fractures. The mortality rate of patients was 3.9% (n = 5). Three patients had dementia at death, four had do-not-resuscitate order, and only two deaths were directly related to pulmonary status. Patients who developed pneumonia (14.7%; n = 19) and required mechanical ventilation for a median of 11 days (3.9%; n = 5) were fewer than those in in previous studies. The morbidity and mortality associated with rib fractures are significantly less than reported in the literature when additional injuries are excluded.