Are the Elderly With Maxillofacial Injuries at Increased Risk of Associated Injuries?

PURPOSE

As the geriatric population continues to increase, more elderly patients with maxillofacial injuries are encountered in emergency rooms. It can be hypothesized that advanced age increases the risk of associated injuries (AIs). The purpose of the study was to estimate the frequency of AI and measure the association between age and risk for AI among a sample of patients with facial fractures.

METHODS

A retrospective cohort study was designed and implemented. The study sample comprised patients aged 18 years or older who presented to the Töölö Trauma Centre, Helsinki University Hospital, Finland, between 2013 and 2018 for diagnosis and treatment of facial fractures. The primary outcome variable was the presence or absence of AI. AI was defined as any major injury outside the facial region, including injuries to brain, major vessels, internal organs or respiratory organs, and fractures. Secondary outcome variables were affected organ system (classified as brain, cranial bone, neck, upper extremity, lower extremity, chest, spine, and abdomen), number of affected organ systems (classified as 1 and ≥2), need for intensive care, and mortality. The primary predictor variable was age (adults vs elderly). Controlled variables were sex, mechanism of trauma, intoxication by alcohol, and type of facial fracture. Descriptive statistics, univariable, and multivariable logistic regression analysis were executed to measure the association between age groups and AI. P value less than .05 was set as the threshold for statistical significance.

RESULTS

Of the total 2,682 patients, 1,931 (72.0%) were adults, and 751 (28.0%) were elderly. Elderly had a 1.6-fold risk (95% confidence interval [CI], 1.5-1.8; P < .001) of AIs as compared with adults. Moreover, after adjusting for mechanism of trauma and type of facial fracture, elderly had 1.8 times greater odds for injuries to 2 or more organ systems (95% CI, 1.3-2.5; P < .001), 2.2 times greater odds for brain injuries (95% CI, 1.6-2.9; P < .001), 2.3 times greater odds for neck injuries (95% CI, 1.5-3.6; P < .001), and 6.8 times greater odds for mortality (95% CI, 2.9-15.6; P < .001).

CONCLUSION

Elderly patients have AIs significantly more frequently than younger adults. Age-specific features should be taken into consideration in the multiprofessional evaluation and treatment of facial fracture patients.