Breaking Good? Insights into Rib Fractures in the Older Adult from a Specialist Geriatric Service

Abstract Background Rib fractures are a common consequence of falls in older adults and have high complication rates. In most Irish Hospitals, rib fractures are managed under undifferentiated medical specialties. We describe the experience of a novel multidisciplinary team at Mater Misericordiae University Hospital, Dublin led by Trauma Geriatricians with a special interest in managing rib fractures. Methods Patients with acute rib fractures admitted under the Trauma Geriatrics Service during the observed period were included. Demographics, Clinical Frailty Scale (CFS), imaging modality and complication rates were collected. An individual chest injury score (STUMBL) was calculated as a predictor of pulmonary complications. We provide a descriptive analysis of this cohort and the potential benefits of specialist Geriatrician input in their care. Results 58 patients were included in the analysis. 78.9% suffered isolated rib trauma, while 22.1% sustained fractures in the presence of polytrauma. 86% (50/58) had multiple rib fractures. Median age was 82years, with female predominance (62.1%). Median CFS was 5. Median STUMBL score was 23. Complications developed in 58.6% (34/58). 89% had a CT Thorax. 43% (25/58) had at least one regional pain block administered. All patients received a bone health assessment, 41% (19/46) were newly commenced on bone protection during admission. Median length of stay (LOS) for all patients was 11 days (Range=2-101). Those discharged directly home/to offsite rehab (76%) had a reduced LOS (median 8 days, range 2-65)30-day mortality was 3.4%. Conclusion Our cohort were frail, sustained multiple rib fractures and had high complication rates. Following admission under a geriatrician osteoporosis treatment rates increased, suggesting a potential hidden benefit to this novel service vs standard care. Those discharged directly home or to offsite rehab had shorter acute hospital admissions, possibly reflective of the strong interdisciplinary links inbuilt within our service.