Influence of the Region of Injury on Risk of Mortality in Severely Injured Patients Stratified by Age: An Analysis of 98,481 Patients from the TraumaRegister DGU®

Background/Objectives: The growing elderly population and concomitant increase in physical activity of older adults has led to a growing number of seriously injured elderly patients. The aim of this retrospective cohort study was to investigate the influence of the leading region of injury in severely injured patients on the risk of mortality in different age groups, with focus on elderly patients. Methods: Data from the TraumaRegister DGU® from 2015 to 2020 were analyzed, including severely injured patients admitted to Swiss, German and Austrian trauma centers. Inclusion criteria were a minimum age of 18 years and an Abbreviated Injury Scale (AIS) score of three or higher in at least one of the body regions. Descriptive analysis and odds ratios for mortality derived from multivariable analysis were calculated, stratified by age and leading region of injury. Results: Out of 213,216 patients, 98,481 met the inclusion criteria. Mortality increased from 6.9% in the control group (18–54 years) to a maximum of 35.9% in the 90+ age group. Leading head injuries had a mortality rate of 22%. The odds ratio for the risk of mortality increased with age and reached a maximum value of 17.0 in the 90+ age group. However, the increase in risk of mortality for leading head injury with increasing age was lower than in the other regions, with an OR of 11.7 in the 90+ age group. In contrast, the group with a leading thoracic injury increased to an OR of 22.5, abdomen to an OR of 75.2 and extremities to an OR of 28.7. Conclusions: The risk of mortality from traumatic head injury is less pronounced in elderly people compared to other injury regions. Our data suggests that traditional scoring systems like the AIS might not display nuances of different injury severities in different age groups, especially for head injuries caused by low-energy trauma and therefore should be reevaluated.