Abstract
BackgroundRib fractures are common in ageing people after trauma and delirium is a complication often seen in acutely hospitalized elderly patients. For both conditions, elderly have an increased risk for institutionalization, morbidity, and mortality. This study is the first to investigate risk factors of delirium in elderly patients with rib fractures after trauma.MethodsA retrospective chart review was performed on patients ≥65 years admitted with rib fractures after blunt chest wall trauma to the Amphia hospital Breda, the Netherlands, between July 2013 and June 2018. Baseline patient, trauma- and treatment-related characteristics were identified. The main objectives were identification of risk factors of delirium and investigation of the effect of delirium on outcomes after rib fractures. Outcomes were additional complications, length of hospital stay, need for institutionalization and mortality within six months.ResultsForty-seven (24.6%) of 191 patients developed a delirium. Independent risk factors for delirium were increased age, physical impairment (lower KATZ-ADL score), nutritional impairment (higher SNAQ score) and the need for a urinary catheter, with odds ratios of 1.07, 0.78, 1.53 and 8.53 respectively. Overall, more complications were observed in patients with delirium. Median ICU and hospital length of stay were 4 and 7 days respectively, of which the latter was significantly longer for delirious patients (p < 0.001). Significantly more patients with delirium were discharged to a nursing home or rehabilitation institution (p < 0.001). The 6-month mortality in delirious patients was nearly twice as high as in non-delirious patients; however, differences did not reach statistical significance.ConclusionDelirium in elderly patients with rib fractures is a serious and common complication, with a longer hospital stay and a higher risk of institutionalization as a consequence. Increased awareness for delirium is imperative, most importantly in older patients, in physically or nutritionally impaired patients and in patients in need of a urinary catheter.
Highlights
Rib fractures are common fragility fractures in the elderly, frequently present after blunt chest wall trauma [1, 2]
The main objective of this study is to describe the incidence, risk factors and outcomes of delirium in elderly patients who have been acutely hospitalized with rib fractures due to blunt chest wall trauma
The main study objectives were to describe the incidence of delirium, to identify risk factors associated with delirium and to investigate the effect of delirium on secondary outcomes after rib fractures in elderly patients admitted to the hospital after blunt chest wall trauma
Summary
Rib fractures are common fragility fractures in the elderly, frequently present after blunt chest wall trauma [1, 2]. A higher number of rib fractures, cardiopulmonary comorbidities, a higher injury severity score (ISS) and the need for a chest tube are risk factors for developing pneumonia, ICU admission, mechanical ventilation, longer hospital stay and death [1, 2, 4,5,6,7]. Rib fractures are common in ageing people after trauma and delirium is a complication often seen in acutely hospitalized elderly patients. For both conditions, elderly have an increased risk for institutionalization, morbidity, and mortality. This study is the first to investigate risk factors of delirium in elderly patients with rib fractures after trauma
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