Age-related risk of acute intracranial injury in craniomaxillofacial trauma: a 16-year cohort study with focus on older adults with isolated facial fractures

Abstract Background Population aging is reshaping craniomaxillofacial (CMF) trauma, but the burden of acute intracranial injury (ICI) in older adults with isolated facial fractures (IFF) remains unclear. We evaluated long-term changes in CMF trauma patterns and acute ICI detected on initial computed tomography (CT), with particular focus on IFF. Methods This retrospective single-center study included 16,069 patients with CT-confirmed CMF fractures between 2010 and 2025 after longitudinal deduplication and eligibility screening. Rule-based natural language processing, validated against independent radiologist review, was used to extract fracture patterns and acute ICI from radiology reports. Temporal trends were assessed with linear regression, and multivariable logistic regression was used to evaluate independent associations with acute ICI. Results Mean age increased over time (β = 0.74 years/year, P < 0.001; R² = 0.77). The proportion of IFF rose from 28.1% in 2010 to 56.4% in 2025, becoming the predominant fracture pattern. Despite this shift, acute ICI burden increased with age, reaching 49.1% in older adults versus 25.5% in young adults. In the overall cohort, age remained independently associated with acute ICI (adjusted odds ratio [aOR], 1.02 per year; 95% confidence interval [CI], 1.02–1.03). In the IFF subgroup, age ≥ 65 years was independently associated with acute ICI versus age < 65 years (aOR, 3.26; 95% CI, 2.74–3.88; P < 0.001). Conclusions Although CMF trauma shifted toward facial-predominant patterns over time, acute ICI burden increased with age. Among patients with IFF, older adults remained at increased risk of acute ICI on initial CT.