Characteristics and Patterns of Facial Fractures in the Elderly Population in the United States Based on Trauma Quality Improvement Project Data

Abstract

With the increase in the elderly population in the United States, the number of people seeking care for trauma injuries is expected to increase. However, nationwide studies on epidemiological profile of elderly facial fractures remain sparse. The authors present the epidemiological measures of elderly facial fractures on national scale. Characteristics of facial fractures among younger adults (18-64 years old) and the elderly population (65-74 years old, 75-84 years old and 85 years and above) have been examined using the 2016 American College of Surgeons-Trauma Quality Improvement Program databank. Variables studied included facial fracture patterns, mechanisms of injury, treatment variables, and demographic descriptive data. Of 104,183 elderly trauma patients, 3415 presented with facial fractures, making up 3.3% (versus 6.5% in younger adults). Majority of facial fractures in 85 and over group (60.7%) were experienced by females, compared to only 19.5% in the younger adult group. Most common mechanism of injury in the elderly was falls, versus motor vehicle trauma in younger adults. The most common type of facial fractures among both groups were nasal fractures. Elderly patients presented with fewer zygoma, mandibular and nasal fractures when compared to younger adults, whereas showing more maxillary/ malar and orbital bone fractures. Elderly patients experienced less operative management (4.3%-8.2%) compared to younger adults (15.6%). Concurrently, mortality rates were higher in the elderly patients (9.9%-11.8%) when compared to the younger adults (8.0%). Elderly patients presented with different causes of injury, distribution of fractures, and rates of operative management compared to younger adults.

Predictors of Facial Fractures in Trauma Patients: Retrospective Review at a Level I Trauma Center

“…Notably, this relationship decreases with age and the trend even reverses with more female patients being affected. 1,9,10 The causes of this are partially demographic changes, with women living longer in the US and most countries, older populations contain a more significant proportion of women. Mechanisms of injury also shift with an aging population.…”

“…15 As the population ages, an increase in risk factors like altered gait, and cognitive and physical impairment puts patients at a higher possibility of falls. 1 Thus, falls become the most common mechanism of injury. Older women affected by osteoporosis are especially susceptible to fractures from lesser forces.…”

“…This is very consistent in the literature with male patients outnumbering the female patients. [1][2][3][8][9][10][11][12]14 One literature review looked at 69 studies from around the world, all of which found facial fractures affecting males at a higher rate, though it did vary by country with male to female ratios ranging from 1.8:1 to 20:1. 8 The variability likely has a lot to do with cultural differences, with gender roles determining the amount women could be exposed to trauma.…”

“…Craniofacial trauma is associated with the highest mortality rate of all forms of trauma in patients above the age of 65. 1 While the chance of facial fractures directly leading to mortality is low, studies have shown the mortality rate is higher in patients with facial fractures. 2,3 Instead, these patients typically succumb to concomitant injuries and complications including severe brain trauma, multiple organ dysfunction, spine injuries, etc.…”

“…12,13 Instead, trauma departments often see a majority of injuries resulting from motor vehicle accidents (MVA's) and assaults. 1,2,[9][10][11] While these mechanisms of injury are well documented, many studies only look at their relative prevalence. They fail to compare facial fracture patients to a control to assess the relative danger each of these mechanisms pose.…”