Rib Fractures in the Elderly

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Mortality Calculation

Mortality=min(2+1.5×(Ribs−1)+(Age≥80)×5+Cfactor​, 25)

• Base Mortality = 2%
• Ribs = Number of rib fractures (each additional rib beyond the first increases mortality by 1.5%)
• Age Factor = 5% if Age ≥ 80, otherwise 0
• Comorbidity Factor CfactorCfactor​:
  • None = 0%
  • Mild (1 condition) = 3%
  • Moderate (COPD or CHF) = 6%
  • Severe (Multiple conditions) = 10%
• The final mortality is capped at 25% to reflect realistic clinical outcomes.

Base Mortality

• Starts at 2%, based on general estimates of 2-6% mortality for elderly patients with rib fractures in recent studies.

Number of Rib Fractures

• Each additional rib fracture beyond the first increases mortality by ~1.5%.
• Based on data showing 6% mortality for 2 fractures and ~15% for 7 fractures, suggesting a gradual rather than exponential increase.

Age Factor

• If the patient is 80 years or older, an additional 5% is added.
• Studies indicate a significant increase in mortality in the 80+ age group compared to those in their 60s or 70s.

Comorbidities Factor

• Mild (1 condition): +3%
• Moderate (COPD or CHF): +6%
• Severe (Multiple serious conditions): +10%
• Based on findings that comorbidities significantly increase mortality risk in elderly trauma patients, particularly COPD and CHF, which impair respiratory recovery.

Capped Mortality

• The final estimate is capped at 25%, as studies show most in-hospital mortality rates for elderly rib fracture patients range between 10-25%, depending on severity and risk factors.

Sources

• Bulger et al. (2000): Mortality increases with rib fractures in elderly trauma patients, with each additional rib adding ~19% increased odds of death.
• Flagel et al. (2005): Elderly patients with 7 rib fractures had ~15% mortality, compared to ~6% with 2 fractures.
• Studies on geriatric trauma (2012-2023): Higher mortality in patients aged 80+, especially with comorbidities like COPD or CHF.