title: Geriatric trauma:  demographics, injuries, and mortality.
abstract: OBJECTIVE
  To identify injuries that elderly sustain during high-energy trauma and determine which are associated with mortality.
  
  
  METHODS
  Retrospective review of prospectively collected database.
  
  
  METHODS
  Academic trauma center.
  
  
  METHODS
  Patients selected from database of all trauma admissions from January 2004 through June 2009. Study population consisted of patients directly admitted from scene of injury who sustained high-energy trauma with at least one orthopaedic injury and were 65 years or older (n = 597).
  
  
  METHODS
  Review of demographics, trauma markers, injuries, and disposition statuses.
  
  
  METHODS
  Statistical analysis using χ test, Student t test, and logistic regression analysis.
  
  
  RESULTS
  The most common fractures were of the rib, distal radius, pelvic ring, facial bones, proximal humerus, clavicle, ankle, and sacrum. The injuries associated with the highest mortality rates were fractures of the cervical spine with neurological deficit (47%), at the C2 level (44%), and of the proximal femur (25%), pelvic ring (25%), clavicle (24%), and distal humerus (24%). The fractures significantly associated with mortality were fractures of the clavicle (P = 0.001), foot joints (P = 0.001), proximal humerus or shaft and head of the humerus (P = 0.002), sacroiliac joint (P = 0.004), and distal ulna (P = 0.002).
  
  
  CONCLUSIONS
  Elderly patients present with significantly worse injuries, remain in the hospital longer, require greater use of resources after discharge, and die at 3 times the rate of the younger population. Although the high mortality rates associated with cervical spine, hip, and pelvic ring fractures were not unexpected, the injuries that were statistically associated with mortality were unexpected. Injuries such as clavicle fracture were statistically associated with mortality. As our population ages and becomes more active, the demographic may gain in clinical importance.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Keller
authors.forename: Marcus F
authors.initials: MF
authors.lastname: Sciadini
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sinclair
authors.forename: Robert V
authors.initials: RV
authors.lastname: O'Toole
mesh_terms: D000368:Aged; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000401:mortality