Geriatric ATV and snowmobile trauma at a rural level 1 trauma center: A blow to the chest.

INTRODUCTION

As the population ages, trauma centers are seeing a significant volume of injured geriatric patients. However, there is limited data on geriatric off-roading incidents. We investigated the injury patterns, severity and outcomes of geriatric versus younger adult all-terrain vehicle (ATV) and snowmobile related trauma with the hypothesis that geriatric patients will have higher mortality and worsened outcomes.

METHODS

The trauma registry at a New England Level 1 trauma center was queried by ICD 9/10 code for adult ATV and/or snowmobile-related trauma from 2011-2019. Data reviewed included demographic, admission, injury, and outcomes data including injury severity score (ISS), abbreviated injury scale (AIS) score, hospital disposition, and mortality. Patients were stratified by age into younger adults (18-64 years old) versus geriatric (65 years and older). Univariate analysis was performed to compare groups.

RESULTS

Over the study period, we identified 390 adult ATV or snowmobile-related trauma patients, of whom 38 were geriatric. The mean ages for the younger adult vs. geriatric cohorts were 41(SD 13) and 73(SD 5), respectively. The majority of patients were male (77%). Compared to younger adults, geriatric patients were more often unhelmeted (66 v 38%, p=0.004) and more likely to present after ATV as opposed to snowmobile trauma (71 v 51%, p=0.028). Geriatric patients more often sustained both any chest trauma (68 v 41%, p=0.003) and severe chest trauma (AIS≥3, 55 v 31%, p=0.022), and more often required tube thoracostomy (26 v 12%, p=0.042). Geriatric patients were also more often discharged to a facility (39 v 14%, p<0.001) compared to younger patients. There were no differences between age cohorts regarding arrival Glasgow coma scale scores, ISS>15, length of stay, ventilator days, complications, or mortality.

CONCLUSIONS

Following ATV or snowmobile-related trauma, geriatric patients were more likely to sustain severe chest trauma and to require additional care upon hospital discharge as compared to younger adults. Primary prevention should focus on encouraging helmet and chest protective clothing use in this geriatric population.