Coroner's Finding: CHAPLIN Gray Clyde

Contributing factors

• failure to recognise serious injury pattern in elderly patient
• inadequate understanding of multiple rib fractures in elderly population
• lack of early specialist consultation
• delayed transfer to tertiary centre
• inadequate pain management
• lack of awareness of mortality rates in elderly with multiple rib fractures
• underestimation of internal injury severity
• absence of high-dependency facilities at rural hospital

Coroner's recommendations

1. That radiological services be made available on weekends and after hours at the Wallaroo Hospital
2. That suspected rib fractures in the elderly be diagnosed in a timely manner
3. That in rural settings a diagnosis of multiple rib fractures in the elderly should give rise to immediate consideration being given by medical practitioners to (a) the need to seek advice from the relevant services provided in tertiary hospitals in Adelaide regarding the patient's management, and (b) the need to transfer the patient to a major trauma centre
4. That education be delivered to medical practitioners, especially medical practitioners working in rural settings and in particular in rural hospitals, concerning the seriousness of multiple rib fractures in elderly patients, including pain management modalities, medical interventions, complications, risk of sudden deterioration, and use of CT imaging over X-ray
5. That a public advertising campaign be instigated in relation to the dangers and possible adverse consequences of use of ladders by the elderly