Thoracic Trauma in the Elderly

In the setting of trauma, age-related changes to the respiratory system predispose the elderly patient to more severe traumatic injury and, consequently, may result in a more prolonged, complicated clinical course. Rib fractures are the most common injury from blunt thoracic trauma; however, associated injuries such as sternal fractures, pulmonary contusions, hemothorax, pneumothorax, and blunt cardiac injury are also seen in this setting. Deleterious pulmonary sequelae such as respiratory failure and pneumonia often occur in the elderly thoracic trauma patient. Furthermore, the overall incidence of mortality is higher in the geriatric patient population than in their younger counterparts when they are equally injured. There is emerging evidence supporting the surgical management of bony thoracic injury, demonstrating that it is both safe and effective. As the elderly patient population continues to grow, evaluation of the elderly trauma patient has become a common clinical encounter. Clinicians caring for these patients should maintain a high index of suspicion for thoracic injury and an appreciation of this population’s intolerance to thoracic trauma.