The importance of increased awareness for delirium in elderly patients with rib fractures after blunt chest wall trauma: a retrospective cohort study on risk factors and outcomes

• Published in: BMC emergency medicine 2019-06, Vol.19 (1), p.34-34, Article 34
• Main Authors: Janssen, Ties L, Hosseinzoi, Elmand, Vos, Dagmar I, Veen, Eelco J, Mulder, Paul G H, van der Holst, Adrianus M, van der Laan, Lijckle
• Format: Article
• Language: English
• Subjects: Activities of daily living; Adverse outcomes; Age; Aged; Aged, 80 and over; Aging; Chest; Cognitive ability; Cohort analysis; Cohort Studies; Comorbidity; Complications; Delirium; Delirium - complications; Delirium - epidemiology; Delirium - rehabilitation; Elderly; Elderly patients; Emergency medical care; Female; Fractures; Fractures (Injuries); Geriatric trauma; Geriatrics; Gerontology; Health risk assessment; Hospital patients; Hospitals; Humans; Impairment; Injuries; Joint surgery; Length of Stay; Male; Medical instruments; Medical research; Mental disorders; Morbidity; Mortality; Netherlands - epidemiology; Older people; Pain management; Patient outcomes; Patients; Pneumonia; Population; Psychotropic drugs; Rehabilitation; Retrospective Studies; Rib; Rib cage; Rib fractures; Rib Fractures - complications; Ribs; Risk analysis; Risk Factors; Surgery; Thoracic Injuries - complications; Thoracic Wall - injuries; Trauma; Treatment Outcome; Ventilators; X-rays
• ISSN: 1471-227X; 1471-227X
• DOI: 10.1186/s12873-019-0248-z

Rib fractures are common in ageing people after trauma and delirium is a complication often seen in acutely hospitalized elderly patients. For both conditions, elderly have an increased risk for institutionalization, morbidity, and mortality. This study is the first to investigate risk factors of delirium in elderly patients with rib fractures after trauma. A retrospective chart review was performed on patients ≥65 years admitted with rib fractures after blunt chest wall trauma to the Amphia hospital Breda, the Netherlands, between July 2013 and June 2018. Baseline patient, trauma- and treatment-related characteristics were identified. The main objectives were identification of risk factors of delirium and investigation of the effect of delirium on outcomes after rib fractures. Outcomes were additional complications, length of hospital stay, need for institutionalization and mortality within six months. Forty-seven (24.6%) of 191 patients developed a delirium. Independent risk factors for delirium were increased age, physical impairment (lower KATZ-ADL score), nutritional impairment (higher SNAQ score) and the need for a urinary catheter, with odds ratios of 1.07, 0.78, 1.53 and 8.53 respectively. Overall, more complications were observed in patients with delirium. Median ICU and hospital length of stay were 4 and 7 days respectively, of which the latter was significantly longer for delirious patients (p