E. D. Porter1, J. L. Goldwag1, A. R. Wilcox1, Z. Li2, A. O. Crockett1, D. J. Mancini1, A. B. Wolffing1, E. D. Martin1, A. Briggs1 2Dartmouth Medical School,Biomedical Data Science,Lebanon, NH, USA 1Dartmouth Hitchcock Medical Center,Surgery,Lebanon, NH, USA
Introduction: Advanced age is a known risk factor for worsened outcomes in trauma, but recent studies have challenged this assumption in sport-related trauma. The aim of this study was to assess the national burden of traumatic injury secondary to skiing and snowboarding in geriatric versus younger adult patients.
Methods: The National Trauma Data Bank (NTDB) was queried for all Level 1 or 2 trauma center encounters for ski and snowboard injuries from 2007-2015 in adults age ≥18 years. Patients were classified as either geriatric (age ≥65) or younger adult (age 18-64). Demographic and clinical data including injury data, Glasgow coma scale (GCS), emergency department disposition including admission to the intensive care unit (ICU), injury severity score (ISS), abbreviated injury scale (AIS), morbidity and mortality were reviewed. Severe injury was defined as an ISS>15 and severe body system injury as an AIS>3. Analysis was performed using Chi square, ANOVA, and Kruskal-Wallis testing as indicated.
Results: A total of 9,833 adult ski or snowboard trauma patients were identified, and 8.9% (873) were geriatric. Mean ages for younger vs geriatric patients were 34.2(±13.9) and 72.3(±5.8) years, respectively. Over 75% (n=7,392) of all patients were male. Geriatric patients were significantly more likely to be skiers than younger patients (92.3 v 53.6%, p<0.0001) and were more likely to be helmeted (66.9 vs. 45.7%, p<0.001). Geriatric patients had higher rates of severe injury (19 v 14.3%, p<0.001) with significantly more head (p<0.0001) and thorax (p=0.001) injuries (Figure 1). Severity of head injury was also greater in geriatric patients both by mean AIS score and rate of AIS > 3 (p<0.0001 and p=0.003), though admission GCS was not different between groups. Younger adults had a higher rate of abdominal injuries (12.6 v 5.7%, p<0.0001). Spine injury rates were higher in younger patients (25.4 v 19.8%, p=0.001) but geriatric patients had more severe spine injuries (14.4 vs 7.7%, p=0.007). A quarter (25.6%) of geriatric patients required ICU admission and the overall length of stay was longer for geriatric patients (p<0.0001). Mortality rates were low overall, but higher in the geriatric population (1.7 v 0.4%, p<0.0001). Upon discharge, 26.5% of geriatric patients required facility care.
Conclusion: Despite the assumed fitness required to ski and snowboard, geriatric trauma patients in these sports are still more severely injured than their younger counterparts, with over a quarter requiring ICU admission and/or discharge to a facility. Additional studies are required to evaluate the specific injuries and risk factors in this active geriatric population to provide strategies for safer participation in skiing and snowboarding.
