Pelvic injuries in elderly trauma patients: epidemiology, injury characteristics, in-hospital care and factors influencing mortality.

BACKGROUND: Pelvic and acetabular fractures are increasing in incidence in elderly patients. Whether the fracture contributes independently to mortality, or merely accompanies the factors that drive it, remains contested, and large national data on elderly trauma patients are limited. The primary aim of this study was to determine factors influencing 30-day mortality in elderly trauma patients, with particular focus on pelvic injuries. Secondary aims included to analyse the influence of these injuries on in-hospital care and discharge destination. METHODS: All patients aged ≥ 60 years admitted as trauma alerts in Sweden between 1 January 2022 and 31 December 2024 were identified through the Swedish Trauma Registry (SweTrau). The primary outcome was 30-day mortality. The association between pelvic injury (pelvic or acetabular fracture) and 30-day mortality was assessed using multivariable logistic regression, adjusting for gender, ASA class, NISS, and head injury. RESULTS: Of 11,624 patients (median age 76 years, 39.7% males), 776 (6.7%) sustained a pelvic injury. Patients with pelvic injury more frequently sustained high-energy trauma, had a higher median NISS (17 vs. 11), longer hospital length of stay (6 vs. 3 days), higher ICU admission rate (30.9% vs. 20.0%), and was less frequent discharged direct home (34.0% vs. 55.8%; all p < 0.001). Crude 30-day mortality was 16.1% vs. 12.5% (p = 0.002) for patients with and without pelvic injury respectively. After adjustment for gender, ASA class, NISS, and head injury, pelvic injury remained independently associated with 30-day mortality (adjusted OR 1.28, 95% CI 1.03-1.57, p = 0.025). CONCLUSION: In a national cohort of elderly trauma patients, pelvic injury was independently associated with increased 30-day mortality, greater in-hospital resource use and greater need for in-patient rehab after discharge, and should be considered a distinct prognostic factor in early risk stratification.