GNRI and PNI for Predicting Short-Term Outcomes in Older Adults With Multiple Rib Fractures

Older adults with multiple rib fractures may have an increased risk of respiratory complications, intensive care admission, prolonged hospitalization, and mortality after thoracic trauma. Nutritional impairment may contribute to this risk through reduced respiratory muscle strength and impaired immune response. The Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) are practical nutritional assessment tools calculated from routinely available clinical and laboratory data.

This is a prospective, single-center, observational cohort study conducted in the Emergency Department of Ankara Etlik City Hospital. The study will include adults aged 65 years or older who present with isolated blunt thoracic trauma and more than three radiologically confirmed rib fractures. Patients will be evaluated during routine clinical care, and no additional treatment, medication, device, or invasive procedure will be administered for research purposes.

GNRI will be calculated using serum albumin, current body weight, and ideal body weight. PNI will be calculated using serum albumin and the total lymphocyte count. Height, weight, albumin, lymphocyte count, injury characteristics, associated thoracic findings, treatment requirements, hospital course, and clinical outcomes will be recorded prospectively.

The primary analysis will assess the association of GNRI and PNI with the composite short-term poor clinical outcome. The prognostic performances of the two indices will be evaluated using receiver operating characteristic curve analysis, area under the curve comparisons, and optimal cut-off values. Multivariable logistic regression analysis will be used to identify factors independently associated with the primary outcome. Hospital outcomes will be obtained from clinical records. Thirty-day emergency department revisit and mortality data will be obtained from available health records or, when necessary, by telephone follow-up.

Inclusion criteria

• Age 65 years or older.
• Presentation to the emergency department with blunt thoracic trauma.
• More than three rib fractures confirmed by thoracic computed tomography or another appropriate radiologic method.
• Isolated thoracic trauma without major extra-thoracic injury.
• Serum albumin level, total lymphocyte count, height, and weight available within the first 24 hours after presentation.
• Written informed consent obtained from the patient or the legally authorized representative.

Exclusion criteria

• Penetrating thoracic trauma.
• Single rib fracture.
• Intubation at presentation.
• Polytrauma or major extra-thoracic injury.
• Known advanced liver failure, nephrotic syndrome, end-stage renal disease, or hematologic disease that may substantially affect albumin or lymphocyte levels.
• Active malignancy or cachexia related to advanced malignancy.
• Missing data.
• Refusal to participate in the study.