Rib Fracture Management in Older Adults: A Scoping Review

Abstract

Background: Unique challenges posed by caring for patients of geriatric age, require concurrent management of chronic comorbidities and strategies to avoid or minimize complications related to the injury and/or hospitalization. The presentation in this population of two or more rib fractures is associated higher morbidity and mortality compared to a younger age group. A lack of guidelines regarding the management of multiple rib fractures in the elderly for primary care providers in the community and the complexity of rib fracture management led to reviewing available evidence regarding various approaches to rib fracture management. Methods: Online databases (PubMed and MEDLINE) were used to identify 57 publications between 2000 and 2022 regarding the management of multiple rib fractures. Results: The majority of publications were retrospective studies and observational cohort studies (56%). 32% of studies were review articles, meta-analyses, and guidelines. Three articles (5.3%) were randomized control studies. Four articles (7%) cited statistics from a national resource. Conclusions: The management of rib fractures is predominantly non-surgical, managed with pain control and respiratory rehabilitation. Triaging protocols, available to healthcare providers in outpatient clinics, urgent care centers, and emergency departments, to identify the most vulnerable patients with rib fractures in a timely fashion likely help expedite the level of care they need. A comprehensive treatment team includes not only the primary trauma team (consisting of emergency physicians/trauma surgeons, trauma nurses, and mid-level practitioners) but also incorporates a multidisciplinary team with the early involvement of a geriatrician, physical therapist, anesthesiologist, social worker, and respiratory therapist when required to improve ventilation, breathing and patient comfort.