Artikel
Thoracic trauma in the elderly - Single center report of treatment and outcome
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Autoren
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R.-M. Marquez-Pinilla
- Chirurgie, Kantonsspital Graubünden, Chur; Thorax- und Gefässchirurgie, Chur
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Y. Acklin
- Chirurgie, Kantonsspital Graubünden, Chur; Thorax- und Gefässchirurgie, Chur
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M. Furrer
- Chirugie, Kantonsspital Graubünden, Chur; Thorax- und Gefässchirurgie, Chur
| Veröffentlicht: | 14. Oktober 2013 |
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Gliederung
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Objective: Thoracic trauma in the elderly patients is associated with an increased morbidity and mortality. Even low energy trauma can cause serious injuries of the chest wall and the thoracic organs and consequent complications such as pulmonary dysfunction and infection seem to be more frequent as in younger patients. The aim of our study was to analyze the results of our treatment of elderly patients after blunt thoracic trauma following a strict algorhism.
Methods: Retrospective, descriptive analysis of diagnosis, treatment, associate complications and clinical course of patients over 60 years after blunt thoracic trauma based on our prospectively defined treatment directives.
Results: 169 patients (age 60 to 94 years) were treated in our departement due to isolated blunt thoracic trauma in the years 2007 to 2012 (all patients with an ISS>16 were excluded). Eighty cases suffered an unilateral serial rib fracture (47.3%) and 41 patients had additional fractures of the clavicula or sternum beside rib fractures (24.2%). Early mobilisation, agressive analgetic treatment including epidural analgesia if necessary and intensive respiratory therapy by specialized physiotherapists – but no prophylactic antibiotic treatment – were the cornerstones of the treatment. Twenty-one (12.4%) patients had a pneumonia in the clinical course. Five cases with empyema were documented (3%). Two patients died after blunt thoracic trauma within 30 days of hospitalisation (1.2%). Most patients were treated conservatively (n=157 ;92.9%). In 6 patients an internal fixation of the ribs, the clavicula or the sternum was performed. 6 patients underwent VATS or thoracotomy. No patient died after surgical treatment. The mean value of hospital stay was 7.9 days (SD +-7.3), only 20 patients were treated on the ICU (11.8%).
Conclusion: Most of the elderly patients with isolated thoracic trauma can be treated conservatively on the normal ward providing adequate analgesia and forced breathing therapy. In cases of severe injuries of the chest wall, locular effusion or empyema surgical therapy should be considered early even in patients with relevant comorbidities. Following this treatment strategy the overall mortality seems to be lower than reported by others (1.2%).
