BACKGROUND Rib fractures are common in ageing people after trauma and delirium is a complication often seen in acutely hospitalized elderly patients. For both conditions, elderly have an increased risk for institutionalization, morbidity, and mortality. This study is the first to investigate risk factors of delirium in elderly patients with rib fractures after trauma. METHODS A retrospective chart review was performed on patients ≥65 years admitted with rib fractures after blunt chest wall trauma to the Amphia hospital Breda, the Netherlands, between July 2013 and June 2018. Baseline patient, trauma- and treatment-related characteristics were identified. The main objectives were identification of risk factors of delirium and investigation of the effect of delirium on outcomes after rib fractures. Outcomes were additional complications, length of hospital stay, need for institutionalization and mortality within six months. RESULTS Forty-seven (24.6%) of 191 patients developed a delirium. Independent risk factors for delirium were increased age, physical impairment (lower KATZ-ADL score), nutritional impairment (higher SNAQ score) and the need for a urinary catheter, with odds ratios of 1.07, 0.78, 1.53 and 8.53 respectively. Overall, more complications were observed in patients with delirium. Median ICU and hospital length of stay were 4 and 7 days respectively, of which the latter was significantly longer for delirious patients (p < 0.001). Significantly more patients with delirium were discharged to a nursing home or rehabilitation institution (p < 0.001). The 6-month mortality in delirious patients was nearly twice as high as in non-delirious patients; however, differences did not reach statistical significance. CONCLUSION Delirium in elderly patients with rib fractures is a serious and common complication, with a longer hospital stay and a higher risk of institutionalization as a consequence. Increased awareness for delirium is imperative, most importantly in older patients, in physically or nutritionally impaired patients and in patients in need of a urinary catheter.

中文翻译：

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老年胸壁钝性外伤后肋骨骨折患者提高del妄意识的重要性：一项回顾性队列研究，涉及危险因素和预后。

背景技术肋骨骨折在外伤后的老年人中很常见，del妄是在急性住院的老年患者中经常看到的并发症。在这两种情况下，老年人的机构化，发病率和死亡率的风险均增加。这项研究是第一个调查老年肋骨骨折患者创伤后ir妄的危险因素。方法对2013年7月至2018年6月间在荷兰布雷达的安菲亚医院对钝性胸壁外伤后≥65岁的肋骨骨折入院的患者进行回顾性图表审查。确定了基线患者，与创伤和治疗相关的特征。主要目的是确定del妄的危险因素，并研究of妄对肋骨骨折后预后的影响。结果是其他并发症，住院时间的长短，需要住院的机构和六个月内的死亡率。结果191名患者中有47名（24.6％）出现a妄。del妄的独立危险因素是年龄增加，身体障碍（KATZ-ADL评分较低），营养障碍（SNAQ评分较高）和需要导尿管，比值比分别为1.07、0.78、1.53和8.53。总体而言，del妄患者观察到更多并发症。ICU中位数和住院天数分别为4天和7天，其中对于精神错乱患者，后者明显更长（p <0.001）。显着更多的ir妄患者被送往疗养院或康复机构（p <0.001）。精神错乱患者的六个月死亡率几乎是非精神错乱患者的两倍。然而，差异未达到统计学意义。结论老年肋骨骨折患者的Deli妄是一种严重且常见的并发症，住院时间更长，因此住院治疗的风险更高。当务之急是提高awareness妄意识，最重要的是老年患者，身体或营养受损的患者以及需要导尿管的患者。