1. The Effect of Chest Wall Injuries on Morbidity and Mortality in the Elderly Cierra Jenkins 1, Dr. Ronald Benenson M.D 1,2. 1 Department of Biological Sciences, York College of Pennsylvania, 2 York Hospital, York, Pennsylvania Introduction Elderly trauma patients are commonly seen in the Emergency Department, with the numbers progressively increasing. Thoracic injuries comprise 10 to 15 percent of all traumas (Sirmali et Al. 2003). Approximately one-third of thoracic trauma patients have fractured ribs ( Sirmali et Al. 2003 ). Factors related to a higher risk of rib fractures in the elderly include osteoporosis and decreased muscle mass (Barnea et Al. 2002). Isolated rib fractures are one of the most common fractures among the elderly (about 12 percent of all fractures), with an increasing incidence recorded over the past 30 years ( Barnea et Al. 2002 ). As a result of rib fractures, elderly patients are at risk for higher morbidity and mortality. This prompted us to ask: Would rib fractures be predictive of a poor medical outcome? To answer this, we chose to use a retropective approach. We selected a study population consisting of a large number of chest wall contusion and rib fracture patients that presented to the York Hospital emergency department during the calendar year of 2005. Patients of age18 and over were included in the study. The population was divided into a younger cohort (18-64) and an elderly cohort (65 and older). Clinical complications, procedures, length of stay (LOS), ICU (Intensive Care Unit) LOS, and disposition were used as markers of morbidity. We hypothesized that patients ≥ age 65 presenting to the emergency department with chest wall injuries will have higher morbidity and mortality compared to patients <age 65. Materials and Methods This was an IRB approved study in an adult population of York hospital emergency department patients. Medical records of patients age 18 and over presenting to the emergency department with chest wall injuries were reviewed retrospectively. A standardized data collection form was utilized. Following HIPPA regulations, patients were assigned a study number on the data collection form. We collected the following data: Patient demographics Type of trauma Comorbidities Number of rib fractures. Admitted patients -complications -dispositon after hospital. A five point scale was used to code the descriptive data into numerical form. A total of 565 patient charts were reviewed and the data was analyzed with SPSS V14.0, utilizing the Spearman’s Rho and the Chi-Square statistical tests. 75 patients were excluded from the study. A five point scale was used to code the descriptive data into numerical form. Discussion No significant relationship between age and morbidity was found. The lack of correlation between age and morbidity most likely occurred because treatment of the patients was not standardized. Depending on the severity of the injury, the patient may not have presented with any complications and may have been discharged to home. We determined injury severity by noting whether the patients were seen by the trauma team (severe) or they were not seen by the trauma team (non-severe). If the patient was seen by the trauma team, it was highly probable that the more severely injured they were, the more likely that they would have experienced rib fractures. As the age of the patients increased, the number of rib fractures increased in a significant manner. This observation is likely due to the fact that the elderly are prone to osteroporosis and decreased muscle mass. To determine the importance of these two factors to the degree of injury, we would have to look for a history or diagnosis of one or both of the two. Ultimately, the results did not support our original hypothesis. References Barnea, Yoav; Kashtan, Hanoch; Skornick, Yehuda; Werbin, Nahum. 2002. Isolated rib fractures in elderly patients: mortality and morbidity. Canadian Journal of Surgery. 45: 43-46 Sirmali, Mehmet; Turut, Hasan; Turut, Hasan; Topcu, Salih; Gulhan, Erkmen; Yazici, Ulku; Kaya, Sadi; Tastepe, Irfan. A comprehensive analysis of traumatic rib fractures: Morbidity, mortality and management. European Journal of Cardio-thoracic Surgery. 24: 133-138. Acknowledgements I would like to give a special thank you to Dr. Ronald Benenson, Rodney Grim, and Dr.John Spitznagel for all of your time and support through this entire project. Results Figure1. This histogram represents the age frequency of patients in the study. rad.usuhs.mil/rad/home/peds/abuse.html Figure 2. Correlation between age, the number of rib fractures, and hospital length of stay as a measure of morbidity. Age frequency of patients included in the study Comparisons MadeR valueN Age vs Number of rib fractures.188**490 Age vs. hospital LOS and ICU LOS.608490 **Correlation was significant at the 0.01level (two-tailed) Clinical ComplicationsValuedfAsymp. Signif. (2 sided) Atelectasis 0.04110.840 Pneumothorax 1.48110.224 Hemothorax 0.28810.591 Pneumonia 0.25110.616 Pulmonary Contusion 2.87510.090 Flail Chest 2.81620.245 Chi Square Tests: Individual Clinical Complications as Measures of Morbidity Spearman Rho Statistic for Measures of Morbidity Figure 3. Chi square analysis results for six surrogate measures of morbidity compared by age cohort. N = 490, No value was found to be significant