Two of the most common causes of rib fractures and emergency room visits are blunt chest trauma from falls or collisions. While most patients who have rib fractures are discharged with pain medications and a spirometer, some patients have a higher mortality risk than others.
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In this article, we’ll explain more about who is at a higher risk for rib fracture as well as the factors that predict mortality rate. in addition, we’ll look at how mortality can be reduced.
Age & Mortality Risk with Rib Fractures
Research shows that 10% to 15% of emergency department trauma visits and 20% of trauma deaths are due to chest trauma. As we get older, the risk of death following chest trauma increases. This is because elderly patients who have rib fractures are at a higher risk for complications including ARDS, pneumonia, and respiratory failure. In addition, elderly patients have longer hospital and ICU stays.
One 10-year study compared younger patients between the ages of 18 to 64 versus those over the age of 64. The results were that 17% of the younger patients and 31% of older patients developed pneumonia. In addition, the mortality rate was 10% for younger patients and 22% for older patients. The risk of developing pneumonia and mortality rates increase with the number of ribs fractured. For each addition fracture, the risk of pneumonia was increased by 1.16, while the risk of death was increased by 1.19.
Mortality rates are comparable among both populations when the number of rib fractures is 5 to 6. This is usually because with 5 to 6 rib fractures, there is another trauma involved such as intra-cranial bleeds, abdominal injuries, or thoracic injuries. Patients with 6 rib fractures are at a higher risk of death from causes unrelated to the fractures.
How are Rib Fractures Diagnosed?
Most rib fracture mortality studies used CXR to diagnose fractures. While CXR does detect most of the more severe fractures, they can miss up to 50%. As more physicians use CT scans to detect fractures, the mortality rate may fall since this imaging can detect some of the more subtle fractures. CT scans can determine whether there are other intra-thoracic injuries and the presence of parenchymal injuries.
Finally, ultrasound is also being used to diagnose rib fractures. However, at this time, this is not a common modality, and we need more research and training to determine its effectiveness.
How to Reduce Mortality with Rib Fractures
The risk of pneumonia is higher in patients with rib fractures because it’s harder to breathe due to the pain. However, by reducing pain, we may also be able to reduce the risk of pneumonia and death.
Studies have examined the use of epidurals versus IV pain medications in the hope that epidurals would control pain and reduce pneumonia rates. One study indicated that pneumonia rates were 18% with epidural versus 38% with IV pain medications. In addition, those who were given an epidural had 50% fewer days on a ventilator than those with IV pain medications. However, other studies have found no significant difference between the two.
If you or a loved one has sustained a rib fracture or needs medical help due to other conditions, consider hiring a caregiver from Caring Healthcare in Columbia, SC. We are family-owned and operated, and we only hire caregivers that we would trust with our own loved ones. We look forward to meeting with you and helping you with your in-home healthcare needs.