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Question 30#

Which is true regarding trauma in geriatric patients?

A. Admission GCS score after severe head injury is a good predictor of outcome
B. Rib fractures are associated with pulmonary contusion in 35% of patients, and complicated by pneumonia in 10 to 30% of patient
C. Approximately 10% of patients older than 65 years will sustain a rib fracture from a fall <6 ft
D. Chronologic age older than 65 years is associated with higher morbidity and mortality after trauma

Correct Answer is B

Comment:

Mortality in patients with severe head injury more than doubles after the age of 55 years. Moreover, 25% of patients with a normal GCS score of 15 had intracranial bleeding, with an associated mortality of 50%. Just as there is no absolute age that predicts outcome, admission GCS score is a poor predictor of individual outcome. Therefore, the majority of trauma centers advocate an initial aggressive approach with reevaluation at the 72-hour mark to determine subsequent care. Secondly, one of the most common sequelae of blunt thoracic trauma is rib fractures. In fact, in one study, 50% of patients older than 65 years sustained rib fractures from a fall of <6 ft, compared with only 1% of patients younger than 65 years. Concurrent pulmonary contusion is noted in up to 35% of patients, and pneumonia complicates the injuries in 10 to 30% of patients with rib fractures.