Long-term functional recovery after rib fractures: The impact of frailty

BACKGROUND Previous studies have shown that patients with rib fractures experience long-term functional limitations. However, the specific predictors of these worse long-term functional limitations remain under-characterized. METHODS We conducted a prospective cohort study including patients >= 18 years with an injury severity score >= 9 and isolated chest injury. Patients included had >= 1 rib fracture and were admitted between July 2015 and May 2019 at one of three Level I trauma centers present in our region. We performed stepwise regression analysis to identify predictors of new functional limitations, i.e., limitations that patients developed postinjury in an activity of daily living. Patients were contacted between 5 and 12 months postinjury to inquire about functional limitations. We assessed frailty using the mFI-5 tool, and a score of 1 was considered moderate frailty, while >1 was considered severe frailty. RESULTS Among 279 included patients, 74 (26.5%) developed new functional limitations. The majority of patients had a displaced fracture [118 (42.3%)] and >= 3 rib fractures [237 (84.9%)]. A proportion of patients had superior rib fractures [105 (37.6%)], concomitant clavicular, scapular, or sternal fractures [64 (22.9%)], flail chest [37 (13.3%)], moderate frailty [106 (38.0%)], and severe frailty [57 (20.4%)]. Severe frailty and discharge to a skilled nursing facility, rehabilitation facility, or other location as opposed to home were predictors of new functional limitations. CONCLUSION In our population, frailty, not injury characteristics, predicted new long-term functional limitations in patients with rib fractures. Frail patients may benefit from additional inpatient and discharge resources for improved long-term outcomes.