Older Adults With Isolated Rib Fractures Do Not Require Routine Intensive Care Unit Admission
Older adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care. We analyzed...
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| Veröffentlicht in: | The Journal of surgical research 2020-01, Vol.245, p.492-499 |
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| creator | Bowman, Jessica A. Jurkovich, Gregory J. Nishijima, Daniel K. Utter, Garth H. |
| description | Older adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care.
We analyzed patients ≥50 y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs.
Among 401 patients, 251 (63%) were admitted to an ICU. Eighty-three patients (33%) admitted to an ICU and 7 (5%) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10%), frequent respiratory therapy (9%), and oxygen desaturation (8%). Predictors of CCIEs included incentive spirometry |
| doi_str_mv | 10.1016/j.jss.2019.07.098 |
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We analyzed patients ≥50 y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs.
Among 401 patients, 251 (63%) were admitted to an ICU. Eighty-three patients (33%) admitted to an ICU and 7 (5%) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10%), frequent respiratory therapy (9%), and oxygen desaturation (8%). Predictors of CCIEs included incentive spirometry <1 L (OR 4.72, 95% CI 2.14-10.45); use of a walker (OR 2.86, 95% CI 1.29-6.34); increased chest Abbreviated Injury Scale score (AIS 3 OR 5.83, 95% CI 2.34-14.50); age ≥72 y (OR 2.68, 95% CI 1.48-4.86); and active smoking (OR 2.11, 95% CI 1.06-4.20).
Routine ICU admission is not necessary for most older adults with isolated rib fractures. The predictors we identified warrant prospective evaluation for development of a clinical decision rule to preclude unnecessary ICU admissions.</description><identifier>ISSN: 0022-4804</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2019.07.098</identifier><identifier>PMID: 31446191</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; Critical Care - standards ; Critical Care - statistics & numerical data ; Female ; Humans ; Hypotension - epidemiology ; Hypotension - etiology ; Hypotension - therapy ; Intensive care unit ; Intensive Care Units - standards ; Intensive Care Units - statistics & numerical data ; Male ; Middle Aged ; Older adult ; Patient Admission - standards ; Patient Admission - statistics & numerical data ; Practice Guidelines as Topic ; Prospective Studies ; Registries - statistics & numerical data ; Retrospective Studies ; Rib fracture ; Rib Fractures - complications ; Rib Fractures - therapy ; Risk Assessment ; Trauma Centers - standards ; Trauma Centers - statistics & numerical data</subject><ispartof>The Journal of surgical research, 2020-01, Vol.245, p.492-499</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-cde110ab8d8b64767f631054c31cb111ecb759084f5ce7a6f621ed593281175f3</citedby><cites>FETCH-LOGICAL-c451t-cde110ab8d8b64767f631054c31cb111ecb759084f5ce7a6f621ed593281175f3</cites><orcidid>0000-0003-0870-8583 ; 0000-0001-7747-3429</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022480419305906$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31446191$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bowman, Jessica A.</creatorcontrib><creatorcontrib>Jurkovich, Gregory J.</creatorcontrib><creatorcontrib>Nishijima, Daniel K.</creatorcontrib><creatorcontrib>Utter, Garth H.</creatorcontrib><title>Older Adults With Isolated Rib Fractures Do Not Require Routine Intensive Care Unit Admission</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description>Older adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care.
We analyzed patients ≥50 y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs.
Among 401 patients, 251 (63%) were admitted to an ICU. Eighty-three patients (33%) admitted to an ICU and 7 (5%) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10%), frequent respiratory therapy (9%), and oxygen desaturation (8%). Predictors of CCIEs included incentive spirometry <1 L (OR 4.72, 95% CI 2.14-10.45); use of a walker (OR 2.86, 95% CI 1.29-6.34); increased chest Abbreviated Injury Scale score (AIS 3 OR 5.83, 95% CI 2.34-14.50); age ≥72 y (OR 2.68, 95% CI 1.48-4.86); and active smoking (OR 2.11, 95% CI 1.06-4.20).
Routine ICU admission is not necessary for most older adults with isolated rib fractures. The predictors we identified warrant prospective evaluation for development of a clinical decision rule to preclude unnecessary ICU admissions.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Critical Care - standards</subject><subject>Critical Care - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotension - epidemiology</subject><subject>Hypotension - etiology</subject><subject>Hypotension - therapy</subject><subject>Intensive care unit</subject><subject>Intensive Care Units - standards</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Older adult</subject><subject>Patient Admission - standards</subject><subject>Patient Admission - statistics & numerical data</subject><subject>Practice Guidelines as Topic</subject><subject>Prospective Studies</subject><subject>Registries - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Rib fracture</subject><subject>Rib Fractures - complications</subject><subject>Rib Fractures - therapy</subject><subject>Risk Assessment</subject><subject>Trauma Centers - standards</subject><subject>Trauma Centers - statistics & numerical data</subject><issn>0022-4804</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kV1rFDEUhoModq3-AG8kl97MmDMz-RgEoay2XSgWFotXEjKZMzbLbNImmQX_vSlbi94IgZDkPU-S8xDyFlgNDMSHXb1LqW4Y9DWTNevVM7IC1vNKCdk-JyvGmqbqFOtOyKuUdqyse9m-JCctdJ2AHlbkx_U8YqRn4zLnRL-7fEs3Kcwm40i3bqDn0di8REz0c6BfQ6ZbvF9cRLoNS3Ye6cZn9MkdkK5N2b7xLhfa3qXkgn9NXkxmTvjmcT4lN-dfvq0vq6vri8367KqyHYdc2REBmBnUqAbRSSEn0QLjnW3BDgCAdpC8Z6qbuEVpxCQawJH3baMAJJ_aU_LpyL1bhj2OFn2OZtZ30e1N_KWDcfrfE-9u9c9w0KJvy2gL4P0jIIb7BVPW5QcW59l4DEvSTaMY51LxpkThGLUxpBRxeroGmH7Qone6aNEPWjSTumgpNe_-ft9TxR8PJfDxGMDSpYPDqJN16C2Opdc26zG4_-B_A6MXnoY</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Bowman, Jessica A.</creator><creator>Jurkovich, Gregory J.</creator><creator>Nishijima, Daniel K.</creator><creator>Utter, Garth H.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0870-8583</orcidid><orcidid>https://orcid.org/0000-0001-7747-3429</orcidid></search><sort><creationdate>20200101</creationdate><title>Older Adults With Isolated Rib Fractures Do Not Require Routine Intensive Care Unit Admission</title><author>Bowman, Jessica A. ; Jurkovich, Gregory J. ; Nishijima, Daniel K. ; Utter, Garth H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-cde110ab8d8b64767f631054c31cb111ecb759084f5ce7a6f621ed593281175f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Critical Care - standards</topic><topic>Critical Care - statistics & numerical data</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotension - epidemiology</topic><topic>Hypotension - etiology</topic><topic>Hypotension - therapy</topic><topic>Intensive care unit</topic><topic>Intensive Care Units - standards</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Older adult</topic><topic>Patient Admission - standards</topic><topic>Patient Admission - statistics & numerical data</topic><topic>Practice Guidelines as Topic</topic><topic>Prospective Studies</topic><topic>Registries - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Rib fracture</topic><topic>Rib Fractures - complications</topic><topic>Rib Fractures - therapy</topic><topic>Risk Assessment</topic><topic>Trauma Centers - standards</topic><topic>Trauma Centers - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bowman, Jessica A.</creatorcontrib><creatorcontrib>Jurkovich, Gregory J.</creatorcontrib><creatorcontrib>Nishijima, Daniel K.</creatorcontrib><creatorcontrib>Utter, Garth H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bowman, Jessica A.</au><au>Jurkovich, Gregory J.</au><au>Nishijima, Daniel K.</au><au>Utter, Garth H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Older Adults With Isolated Rib Fractures Do Not Require Routine Intensive Care Unit Admission</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>245</volume><spage>492</spage><epage>499</epage><pages>492-499</pages><issn>0022-4804</issn><eissn>1095-8673</eissn><abstract>Older adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care.
We analyzed patients ≥50 y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs.
Among 401 patients, 251 (63%) were admitted to an ICU. Eighty-three patients (33%) admitted to an ICU and 7 (5%) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10%), frequent respiratory therapy (9%), and oxygen desaturation (8%). Predictors of CCIEs included incentive spirometry <1 L (OR 4.72, 95% CI 2.14-10.45); use of a walker (OR 2.86, 95% CI 1.29-6.34); increased chest Abbreviated Injury Scale score (AIS 3 OR 5.83, 95% CI 2.34-14.50); age ≥72 y (OR 2.68, 95% CI 1.48-4.86); and active smoking (OR 2.11, 95% CI 1.06-4.20).
Routine ICU admission is not necessary for most older adults with isolated rib fractures. The predictors we identified warrant prospective evaluation for development of a clinical decision rule to preclude unnecessary ICU admissions.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31446191</pmid><doi>10.1016/j.jss.2019.07.098</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-0870-8583</orcidid><orcidid>https://orcid.org/0000-0001-7747-3429</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Age Factors Aged Aged, 80 and over Critical Care - standards Critical Care - statistics & numerical data Female Humans Hypotension - epidemiology Hypotension - etiology Hypotension - therapy Intensive care unit Intensive Care Units - standards Intensive Care Units - statistics & numerical data Male Middle Aged Older adult Patient Admission - standards Patient Admission - statistics & numerical data Practice Guidelines as Topic Prospective Studies Registries - statistics & numerical data Retrospective Studies Rib fracture Rib Fractures - complications Rib Fractures - therapy Risk Assessment Trauma Centers - standards Trauma Centers - statistics & numerical data |
| title | Older Adults With Isolated Rib Fractures Do Not Require Routine Intensive Care Unit Admission |
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