Blunt chest trauma in the elderly
Allen, J.E.; Schwab, C.W.
American Surgeon 51(12): 697-700
1985
ISSN/ISBN: 0003-1348 PMID: 4073681 Document Number: 261539
Forty-eight patients over 60 years of age who had sustained blunt chest trauma were evaluated by injury, treatment, survival, and return to preinjury function. The patients ranged in age from 60-92 years (mean 72). The cause of injury was a fall in 25 (52.1%) and motor vehicle accident in 20 (41.7%). Twenty-three (47.9%) patients had major extrathoracic injuries. The average Injury Severity Score was 18 (range 5-41). Seven (14.6%) patients were treated with ventilation; six of these patients had flail chests, and four (57.1%) intubated patients developed pulmonary complications. Nonventilatory therapy was utilized in 41 (85.4%) patients; there were two (4.9%) treatment failures who required subsequent intubation. Six of 41 (14.6%) developed pneumonia. There was one death overall, yielding a mortality rate of 2.1%. Forty-three (89.6%) patients were discharged home: 39 (81.3%) to an independent life and four (8.3%) requiring partial assistance. Four (8.3%) required long term nursing home care. Severe chest trauma alone does not forecast a poor outcome in the elderly. Most elderly patients who sustain blunt chest trauma will be able to return to an independent life. Nonventilatory therapy, where indicated, is preferred to reduce severe pulmonary complications. Antecedent nutritional depletion may indicate the need for ventilatory therapy in the elderly chest trauma patient.