Sternal fractures and injury severity score in older adults

Traumatic sternal fractures (SF) are rare thoracic injuries, but their clinical impact is greater in older adults with frailty and comorbidities. Concomitant rib fractures often complicate outcomes, but data in geriatric populations remain limited. This study retrospectively analyzed patients aged ≥ 60 years admitted with radiologically confirmed SF at a tertiary care hospital. Data on demographics, clinical features, labs, imaging, and injury severity were collected. The primary outcome was intensive care unit (ICU) admission; secondary outcomes included hospital length of stay and in-hospital mortality. A total of 127 patients (mean age 70.9 ± 8.5 years; 70.9% male) were included. Motor vehicle accidents were the most frequent cause (54.3%), and falls were second (26.8%). Of the patients, 44.9% had rib fractures and also had significantly higher ICU admission rates (61.4% vs. 18.6%, p < 0.001), extended hospital stays, and more severe lab and physiologic problems. ICU care was needed by 37.8%, and in-hospital mortality was 4.7% overall and occurred exclusively among patients with concomitant rib fractures. Multivariate regression showed NISS to be the only independent predictor of ICU admission (Odds ratio [OR] 1.099; 95% Confidence Interval [CI] 1.031–1.171; p = 0.004). In older adults with SF, rib fractures and more severe injuries significantly increase ICU use and mortality rates. NISS was independently associated with ICU admission and may serve as an objective tool for retrospective risk stratification. Early identification of high-risk patients could optimize ICU resource allocation and improve outcomes in this vulnerable population. Not applicable.