A stepwise logistic regression analysis of factors affecting morbidity and mortality after thoracic trauma: effect of epidural analgesia.

Rib fractures and other chest wall injuries can lead to weak ventilation, atelectasis, and even death. Whereas such injuries in young patients are usually well tolerated, relatively minor chest wall trauma can be serious in elderly patients. Epidural analgesia, by improving pain control and ventilatory function, might improve morbidity and mortality rates compared to other forms of analgesia. Stepwise logistic regression was used to compare thoracic trauma patients more than 60 years of age treated with either epidural or parenteral (IV/IM) analgesia. In spite of more severe thoracic trauma in epidural patients as measured by the Abbreviated Injury Score for the chest (epidural = 3.3 +/- 0.1, IV/IM = 2.8 +/- 0.1; p less than 0.05) the use of epidural analgesia was an independent predictor of both decreased mortality (p = 0.0035) and a decreased incidence of pulmonary complications (p = 0.0088). Epidural analgesia has a positive effect on outcome in elderly trauma victims with chest wall injury and is useful in high-risk patients. Increased costs associated with epidural analgesia are minimal and are justified by improvements in outcome.