90th Annual Meeting Abstracts
Factors Associated with Survival Following Blunt Chest Trauma in Older Patients: Results from a Large Regional Trauma Cooperative
D T Harrington, MD1, *N. Zacharias, MD2, G. Velmahos, MD2, M. Rosenblatt, MD3, *E. Winston, MD4, *L. Patterson, MD4, *S. Dejardins5, B. Cushing, MD5, *S. Brotman, MD6, *J. Schulz, MD7, *A. Maung, MD8, *K. Davis, MD8
1Rhode Island Hospital/Alpert Medical School, Providence, RI;2Massachusetts General Hospital, Boston, MA;3Lahey Clinic, Burlington, MA;4Baystate Medical Center, Springfield, MA;5Maine Medical Center, Portland, ME;6Berkshire Medical Center, Pittsfield, MA;7Bridgeport Hospital, Bridgeport, CT;8Yale Medical Center, New Haven, CT
Objective: Blunt chest trauma is associated with high rates of morbidity and mortality in older patients. Small, single institution studies have shown that determinants of morbidity are number of rib fractures (RF) and the use of epidural anesthesia, but large multi-institutional studies are lacking. A large regional trauma outcome cooperative with Level I and Level II centers looked at the determinants of survival in older patients with RF.
Design: Patients > 50 years, with >=1 RF were retrospectively studied. Data included institutional data, patient data, clinical interventions, and complications. Single variable and multivariable (logistic regression) analyses were performed.
Setting/Patients: Eight centers participated. 1621 patients were studied.
Main Outcome Measure: Survival.
Results: Average age was 70.1 years, #RF 3.7, AIS chest 2.7, ISS 11.7 and overall morality was 4.6%. Univariable analysis found increased mortality to be associated with: admission to centers with large number of yearly trauma admissions (HighVolume) and Level I trauma centers; patients with pre-existing CAD or CHF; increasing age, ISS, #RF; and patients who required intubation or developed a pneumonia. Multivariable analysis identified HighVolume, CHF, increasing age and ISS, and the need for intubation to be the strongest independent predictors for mortality. Using this predictive model the use of PCA and tracheostomy appeared to impart a protective effect on survival.
Conclusion: In a large regional trauma cooperative we confirmed that increasing age and ISS were independent predictors of survival. The presence of CHF, the need for intubation, and admission to a HighVolume center added to mortality. Therapies associated with improved survival were the use of PCA and tracheostomy. Further regional cooperation should allow for development of standard care practices for these challenging patients.