The revised cardiac risk index is associated with morbidity and mortality independent of injury severity in elderly patients with rib fractures

• Published in: Injury 2023-01, Vol.54 (1), p.56-62
• Main Authors: Bass, Gary Alan, Duffy, Caoimhe C, Kaplan, Lewis J, Sarani, Babak, Martin, Niels D, Ismail, Ahmad Mohammad, Cao, Yang, Forssten, Maximilian Peter, Mohseni, Shahin
• Format: Article
• Language: English
• Subjects: Aged; Geriatric; Humans; Injury Severity Score; Morbidity; Myocardial Infarction - epidemiology; Retrospective Studies; Revised cardiac risk index; Rib fracture; Rib Fractures - complications; Risk Factors; Risk stratification; Thoracic Injuries - complications; Thoracic trauma
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2022.11.039

Risk factors for mortality and in-hospital morbidity among geriatric patients with traumatic rib fractures remain unclear. Such patients are often frail and demonstrate a high comorbidity burden. Moreover, outcomes anticipated by current rubrics may reflect the influence of multisystem injury or surgery, and thus not apply to isolated injuries in geriatric patients. We hypothesized that the Revised Cardiac Risk Index (RCRI) may assist in risk-stratifying geriatric patients following rib fracture. All geriatric patients (age ≥65 years) with a conservatively managed rib fracture owing to an isolated thoracic injury (thorax AIS ≥1), in the 2013-2019 TQIP database were assessed including demographics and outcomes. The association between the RCRI and in-hospital morbidity as well as mortality was analyzed using Poisson regression models while adjusting for potential confounders. 96,750 geriatric patients sustained rib fractures. Compared to those with RCRI 0, patients with an RCRI score of 1 had a 16% increased risk of in-hospital mortality [adjusted incidence rate ratio (adj-IRR), 95% confidence interval (CI): 1.16 (1.02-1.32), p=0.020]. An RCRI score of 2 [adj-IRR (95% CI): 1.72 (1.44-2.06), p