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311 Rib Fractures in Geriatric Trauma: A Review of 1,037 Cases at a Single Level I Trauma Center
- Forest Sheppard, Joseph D. Mack, Carolyne Falank, Bryan C Morse, Daniel C Cullinane, Joseph F Rappold, Julianne Ontengco, David Ciraulo
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- Journal:
- Journal of Clinical and Translational Science / Volume 6 / Issue s1 / April 2022
- Published online by Cambridge University Press:
- 19 April 2022, pp. 54-55
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- Article
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OBJECTIVES/GOALS: Rib fractures are common traumatic thoracic injuries and are associated with high rates of morbidity and mortality. In those age ≥ 65, the rate of these complications double. This study sought to identify the extent to which injury-related predictors influence clinical outcomes in geriatric patients with rib fractures. METHODS/STUDY POPULATION: A retrospective 5-year review was performed of a single Level 1 Trauma center registry. Geriatric patients (≥65 years of age) diagnosed with rib fractures from January 1, 2014 to December 31, 2019 were included. The primary outcome of interest was in-hospital mortality. Secondary outcomes included hospital and intensive care unit length of stay (HLOS and ICU LOS, respectively) and discharge disposition, as a surrogate for loss of independence. Further, subgroup analysis based on number of rib fractures (i.e. <4 and ≥4 rib fractures) was performed. RESULTS/ANTICIPATED RESULTS: 2,134 adult trauma patients were admitted with at least one rib fracture. Of these, 1,037 (49%) were ≥ 65 years old. This cohort had a mean age of 78.6 years old, injury severity score (ISS) of 11.4, HLOS of 7.4 days and 29% required ICU care with mean ICU LOS of 1.9 days. Only 36% were discharged home compared to 64% who were discharged to a care facility and thus had a loss of independence. Overall mortality was 6.3%. Compared to survivors, non-survivors had a higher ISS (19.3 vs. 10.8, p = < 0.0001) and longer ICU LOS (7.1 vs. 6.5 days, p = 0.04). Analysis based on number of rib fractures showed that those with ≥4 rib fractures had significantly higher mortality (8% vs. 4%, p = 0.008), longer HLOS (8.7 vs. 6.1 days, p < 0.0001), longer ICU LOS (2.6 vs. 1.3 days, p < 0.0001), and significantly lower discharge to home (32% vs. 39%, p = 0.02). DISCUSSION/SIGNIFICANCE: To our knowledge, this is the largest single-center study of geriatric patients with rib fractures. In this study, the observed mortality in patients ≥65 years of age was 6.3% which represents a lower mortality rate than historically reported. Despite this, only 36% were able to be discharged directly to home.
Contributors
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- By Rony A. Adam, Gloria Bachmann, Nichole M. Barker, Randall B. Barnes, John Bennett, Inbar Ben-Shachar, Jonathan S. Berek, Sarah L. Berga, Monica W. Best, Eric J. Bieber, Frank M. Biro, Shan Biscette, Anita K. Blanchard, Candace Brown, Ronald T. Burkman, Joseph Buscema, John E. Buster, Michael Byas-Smith, Sandra Ann Carson, Judy C. Chang, Annie N. Y. Cheung, Mindy S. Christianson, Karishma Circelli, Daniel L. Clarke-Pearson, Larry J. Copeland, Bryan D. Cowan, Navneet Dhillon, Michael P. Diamond, Conception Diaz-Arrastia, Nicole M. Donnellan, Michael L. Eisenberg, Eric Eisenhauer, Sebastian Faro, J. Stuart Ferriss, Lisa C. Flowers, Susan J. Freeman, Leda Gattoc, Claudine Marie Gayle, Timothy M. Geiger, Jennifer S. Gell, Alan N. Gordon, Victoria L. Green, Jon K. Hathaway, Enrique Hernandez, S. Paige Hertweck, Randall S. Hines, Ira R. Horowitz, Fred M. Howard, William W. Hurd, Fidan Israfilbayli, Denise J. Jamieson, Carolyn R. Jaslow, Erika B. Johnston-MacAnanny, Rohna M. Kearney, Namita Khanna, Caroline C. King, Jeremy A. King, Ira J. Kodner, Tamara Kolev, Athena P. Kourtis, S. Robert Kovac, Ertug Kovanci, William H. Kutteh, Eduardo Lara-Torre, Pallavi Latthe, Herschel W. Lawson, Ronald L. Levine, Frank W. Ling, Larry I. Lipshultz, Steven D. McCarus, Robert McLellan, Shruti Malik, Suketu M. Mansuria, Mohamed K. Mehasseb, Pamela J. Murray, Saloney Nazeer, Farr R. Nezhat, Hextan Y. S. Ngan, Gina M. Northington, Peggy A. Norton, Ruth M. O'Regan, Kristiina Parviainen, Resad P. Pasic, Tanja Pejovic, K. Ulrich Petry, Nancy A. Phillips, Ashish Pradhan, Elizabeth E. Puscheck, Suneetha Rachaneni, Devon M. Ramaeker, David B. Redwine, Robert L. Reid, Carla P. Roberts, Walter Romano, Peter G. Rose, Robert L. Rosenfield, Shon P. Rowan, Mack T. Ruffin, Janice M. Rymer, Evis Sala, Ritu Salani, Joseph S. Sanfilippo, Mahmood I. Shafi, Roger P. Smith, Meredith L. Snook, Thomas E. Snyder, Mary D. Stephenson, Thomas G. Stovall, Richard L. Sweet, Philip M. Toozs-Hobson, Togas Tulandi, Elizabeth R. Unger, Denise S. Uyar, Marion S. Verp, Rahi Victory, Tamara J. Vokes, Michelle J. Washington, Katharine O'Connell White, Paul E. Wise, Frank M. Wittmaack, Miya P. Yamamoto, Christine Yu, Howard A. Zacur
- Edited by Eric J. Bieber, Joseph S. Sanfilippo, University of Pittsburgh, Ira R. Horowitz, Emory University, Atlanta, Mahmood I. Shafi
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- Book:
- Clinical Gynecology
- Published online:
- 05 April 2015
- Print publication:
- 23 April 2015, pp viii-xiv
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21 - Managing wolf–human conflict in the northwestern United States
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- By Edward E. Bangs, US Fish and Wildlife Service, USA, Joseph A. Fontaine, US Fish and Wildlife Service, USA, Michael D. Jimenez, US Fish and Wildlife Service, USA, Thomas J. Meier, US Fish and Wildlife Service, USA, Elizabeth H. Bradley, University of Montana, USA, Carter C. Niemeyer, US Fish and Wildlife Service, USA, Douglas W. Smith, National Park Service, USA, Curt M. Mack, Nez Percé Tribe, USA, Val Asher, Turner Endangered Species Fund, USA, John K. Oakleaf, US Fish and Wildlife Service, USA
- Edited by Rosie Woodroffe, University of California, Davis, Simon Thirgood, Zoological Society, Frankfurt, Alan Rabinowitz, Wildlife Conservation Society, New York
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- Book:
- People and Wildlife, Conflict or Co-existence?
- Published online:
- 23 November 2009
- Print publication:
- 25 August 2005, pp 340-356
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Summary
INTRODUCTION
The grey wolf (Canis lupus) is the most widely distributed large carnivore in the northern hemisphere (Nowak 1995) and has a reputation for killing livestock and competing with human hunters for wild ungulates (Young 1944; Fritts et al. 2003). Wolves rarely threaten human safety, but many people still fear them. In the western USA, widespread extirpation of ungulates by colonizing settlers, wolf depredation on livestock and negative public attitudes towards wolves resulted in extirpation of wolf populations by 1930 (Mech 1970; McIntyre 1995). By 1970, mule deer (Odocoileus hemionus), white-tailed deer (O. virginianus), elk (Cervus elaphus), moose (Alces alces) and bighorn sheep (Ovis canadensis) populations had been restored throughout the western USA while bison (Bison bison) were recovered only in Yellowstone National Park. However, grey wolves were still persecuted. In 1974, grey wolves were protected and managed by the US Fish and Wildlife Service under the federal Endangered Species Act of 1973.
In 1986, the first recorded den in the western USA in over 50 years was established in Glacier National Park by wolves that naturally dispersed from Canada (Ream et al. 1989). Restoration of wolves in that region emphasized legal protection and building local public tolerance. Wolves from Canada were reintroduced to central Idaho and Yellowstone National Park in 1995 and 1996 to accelerate restoration (Bangs and Fritts 1996; Fritts et al. 1997). The Northern Rocky Mountains wolf population grew from 10 wolves in 1987 to 663 wolves by 2003 (US Fish and Wildlife Service et al. 2003) (Fig. 21.1, Table 21.1).
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