(432) Evaluating Adverse Discharge Dispositions in Geriatric Trauma Patients With Isolated Rib Fractures

Introduction: Rib fractures in the elderly are a significant cause of trauma center admissions, with higher levels of morbidity and mortality in this population. With the increased level of frailty, these injuries cause higher rates of complications during recovery. We propose that trauma patients over the age of 65 with three or more rib fractures have a high probability of requiring additional medical services after discharge from the hospital.

Methods: We conducted a retrospective review of patients 65 years of age or older, sustaining isolated fracture of 3 or more ribs, who were admitted to a Level I Trauma Center from 2019-2023. The following outcomes were evaluated: Intensive Care Unit (ICU) admission, ICU and hospital length of stay, discharge disposition, hospital complications, and mortality.

Results: There were 82 patients that met criteria, we found that the average Injury Severity Score (ISS) was 9, with most injuries resulting from falls (90%). The average hospital stay was 5.2 days; 41 (50%) of the patients were admitted to an ICU, with an average ICU stay of 3.87 days. Hospital complications included pulmonary embolism, ICU delirium, ICU readmission, deep tissue injury, and one mortality. The discharge outcomes varied, with 34% of patients being discharged home without additional services, 28% being discharged with home health services, and 26.8% being discharged to additional care facilities; primarily skilled nursing facilities (23%) vs. inpatient rehabilitation (3.6%).

Conclusions: In conclusion, a substantial percentage of these patients required additional medical services after discharge. Our study underscores the necessity of healthcare providers building a framework for early discussions with patients and their families regarding the ongoing care and disposition of elderly trauma patients.