Facial trauma in older patients – facing the facts! A 10-year review at a UK major trauma centre

Introduction

Older patients are at a higher risk of suffering injuries that are classed as major trauma (MT), due to a variety of factors. Injuries to the orofacial region present unique challenges in their management, necessitating a balance between functional and aesthetic demands. Despite these challenges, few studies to date have considered how a facial injury may impact outcomes in the older population. We describe a 10-year review at a major trauma centre (MTC) of older patients, who present with facial injuries alongside MT.

Methods

Data for patients over 65 years old who attended our MTC and had a recorded facial injury in the period 2013-2023 were reviewed. A descriptive analysis was undertaken, evaluating injuries sustained, gender, mechanism of injury, length of stay, 30-day outcome, ICU stay, and Glasgow outcome score.

Results

Over the 10-year period evaluated, 26% patients who attended our centre with MT including a facial injury were over 65 years of age. Of the injuries sustained, 81.4% were due to falls, whereas this only accounted for 33.5% in the under 65s population. Injuries were more frequent in the final 3 months of the year, consistent with the increased risk of falls in these months. Where 44.9% patients under 65 were admitted to ICU due to their injuries, this figure dropped to 31% in the over 65s group. Only 28.6% patients were reported as having made a full recovery, with 41.6% suffering moderate/severe disability, and 26.3% resulting in death.

Conclusion

Facial injuries are a common finding in patients over 65 who present with MT. Our single-centre review showed falls to be the single largest cause of facial injuries in this cohort, and ongoing moderate/severe disability was the most common outcome. This study highlights the frequency, distribution and outcomes of facial injuries in the older patient.