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The purpose of this study was to show that elderly patients admitted with rib fractures after blunt trauma have increased mortality.Demographic, injury severity, and outcome data on a cohort of consecutive adult trauma admissions with rib fractures to a tertiary care trauma center from April 1, 1993, to March 31, 2000, were extracted from our trauma registry.Among 4,325 blunt trauma admissions, there were 405 (9.4%) patients with rib fractures; 113 were aged ≥ 65. Injuries were severe, with Injury Severity Score (ISS) ≥ 16 in 54.8% of cases, a mean hospital stay of 26.8 ± 43.7 days, and 28.6% of patients requiring mechanical ventilation. Mortality (19.5% vs. 9.3%;p < 0.05), presence of comorbidity (61.1% vs. 8.6%;p < 0.0001), and falls (14.6% vs. 0.7%;p < 0.0001) were significantly higher in patients aged ≥ 65 despite significantly lower ISS (p = 0.031), higher Glasgow Coma Scale score (p = 0.0003), and higher Revised Trauma Score (p < 0.0001). After adjusting for severity (i.e., ISS and Revised Trauma Score), comorbidity, and multiple rib fractures, patients aged ≥ 65 had five times the odds of dying when compared with those < 65 years old.Despite lower indices of injury severity, even after taking account of comorbidities, mortality was significantly increased in elderly patients admitted to a trauma center with rib fractures.