Refereed journal article or data article (A1)

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




List of Authors: Kokko Linda-Lotta, Puolakkainen Tero, Suominen Auli, Snäll Johanna, Thorén Hanna

Publisher: W.B. Saunders

Publication year: 2022

Journal: Journal of Oral and Maxillofacial Surgery

Journal name in source: Journal of Oral and Maxillofacial Surgery

Volume number: 80

Issue number: 8

eISSN: 1531-5053

DOI: http://dx.doi.org/10.1016/j.joms.2022.04.018

URL: https://doi.org/10.1016/j.joms.2022.04.018

Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/175721881


Abstract

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.

Adult patients with facial fractures typically have these features: they are predominantly male, there is a high frequency of assault-related trauma, and they commonly include a mandibular fracture.1 In geriatric patients, on the other hand, females are often in the majority, with their injuries most commonly being due to falls. Additionally, facial fractures in geriatric patients are most often sustained in the orbital-zygomatic-maxillary complex.2,3 Compared to younger adults, several characteristics in the elderly leave them susceptible to different types of injury mechanisms and injuries. Age-related physiological changes, cognitive and somatic comorbidities, and polypharmacy increase the risk of multiple injuries in general and severe injuries in particular. Despite this, geriatric facial trauma has received fairly little attention in the literature.

We have previously observed that some 25% of patients with facial fractures have associated injuries (AIs) outside the facial region4 and that AIs are significantly more common in geriatric patients than in patients aged 20-50 years.5 Since the publication of these 2 studies, we have observed an increase in the yearly number of facial fracture patients in general, and geriatric patients in particular. This suggests a need for targeted screening to detect changes in injury patterns.

The aim of the present study was to clarify the occurrences and types of AIs in a sample of patients with facial fractures. The specific aims were to 1) estimate and compare the frequencies of AIs between adults and elderly patients and 2) identify risk factors associated with AIs. We hypothesized that AIs are more frequent in elderly patients and that their injury characteristics differ from those in younger adults.


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Last updated on 2022-16-08 at 13:14