Geriatric All-Terrain Vehicle Trauma: An Unhelmeted and Severely Injured Population

Background: All-terrain vehicle (ATV) use is widespread, however, little is known about injury patterns and outcomes in geriatric patients. We hypothesized that geriatric patients would have distinct and more severe injuries than non-geriatric adults after ATV trauma. Methods: A retrospective cohort study was performed using the National Trauma Databank comparing non-geriatric (18-64) and geriatric adults ( >65) presenting after ATV trauma at Level 1 and 2 trauma centers from 2011 to 2015. Demographic, admission, and outcomes data were collected, including injury severity score (ISS), abbreviated injury scale (AIS) score, discharge disposition, and mortality. We performed univariate statistical tests between cohorts and multiple logistic regression models to assess for risk factors associated with severe injury (ISS > 15) and mortality. Results: 23,568 ATV trauma patients were identified, of whom 1,954 (8.3%) were geriatric. Geriatric patients had higher rates of severe injury(29.2 v 22.5%,p < 0.0001), and thoracic (55.2 v 37.8%,p < 0.0001) and spine (31.5 v 26.0%,p < 0.0001) injuries, but lower rates of abdominal injuries (14.6 v 17.9%,p < 0.001) as compared to non-geriatric adults. Geriatric patients had overall lower head injury rates (39.2 v 42.1%,p = 0.01), but more severe head injuries (AIS > 3) (36.2 vs 30.2%,p < 0.001). Helmet use was significantly lower in geriatric patients (12.0 v 22.8%,p < 0.0001). On multivariate analysis age increased the odds for both severe injury (OR 1.50, 95% CI 1.31-1.72, p < 0.0001) and mortality (OR 5.07, 95% CI 3.42-7.50, p < 0.0001). Conclusions: While severe injury and mortality after ATV trauma occurred in all adults, geriatric adults suffered distinct injury patterns and were at greater risk for severe injury and mortality.