Background
Geriatric head and neck trauma represents a growing clinical challenge in modern healthcare systems. In Germany, with a rapidly aging population, the burden on high-level trauma centres has risen as more older patients sustain injuries from low-energy falls, motor vehicle incidents, and other mechanisms. This article synthesizes an 8-year experience at a German highest-level trauma centre (2018–2024) to evaluate presentation patterns, diagnostic approaches, treatment decisions, and outcomes in elderly patients with head and neck trauma. The aim is to provide actionable insights for clinicians, administrators, and researchers seeking to optimize assessment and care pathways for this vulnerable group.
Methods and patient population
Data were drawn from consecutive adult patients aged 65 and older presenting with head or neck injuries to a national-level trauma centre between 2018 and 2024. Variables included demographics, mechanism of injury, initial clinical status (Glasgow Coma Scale, vital signs), imaging results (CT/MRI when indicated), Antithrombotic therapy, frailty indicators, in-hospital interventions, complications, length of stay, and mortality. Frailty was assessed where available using standard indices, acknowledging that geriatric patients often present with multimorbidity and polypharmacy that influence management decisions.
Key findings: presentation and mechanisms
Across the study period, falls remained the leading mechanism of head and neck trauma in older adults, with a notable proportion of patients presenting with low-energy injuries despite advanced age. Penetrating injuries were uncommon in this cohort. Coexisting comorbidities, cognitive impairment, and polypharmacy were frequent, contributing to risk stratification challenges on arrival. Notably, a subset of patients arrived with anticoagulant or antiplatelet therapy, raising concerns for delayed intracranial hemorrhage and influencing imaging and observation strategies.
Initial assessment and imaging
Early and thorough assessment focused on rapid airway, breathing, and circulation evaluation, followed by neurologic examination. Given the elderly physiology and the risks of missed intracranial pathology, CT imaging of the head and cervical spine was commonly employed as part of an expedited diagnostic algorithm. In selected cases, MRI was pursued to clarify soft-tissue or posterior fossa injuries, particularly when CT findings were equivocal or when patients presented with persistent neurocognitive symptoms without overt imaging abnormalities.
Management strategies
Management balanced trauma control with geriatric-specific considerations. For patients with intracranial injuries, decisions regarding observation versus neurosurgical intervention depended on imaging findings, clinical trajectory, and comorbidity burden. Antithrombotic management required careful weighing of bleeding risk against thromboembolic threats, often necessitating multidisciplinary coordination with neurosurgery, geriatrics, and hematology. Frailty scores, nutritional status, and functional baselines were increasingly integrated into discharge planning to optimize recovery potential and reduce hospital-associated complications.
Outcomes and complications
Overall in-hospital mortality remained resource-intensive in the oldest age groups, particularly among those with high frailty indices or significant intracranial pathology. Length of stay varied with injury severity, comorbidity burden, and discharge disposition. Complications included delirium, infections, and post-traumatic cognitive decline, underscoring the need for proactive geriatric rehabilitation and careful post-discharge support.
Implications for practice
The analysis highlights several practice-implications for geriatric trauma care in high-level centres: (1) standardized rapid imaging protocols for elderly head and neck injuries, (2) robust protocols for managing anticoagulation in the context of potential intracranial injury, (3) incorporation of frailty assessments into triage and care planning, (4) multidisciplinary teams with geriatrics, neurosurgery, radiology, and rehabilitation services, and (5) structured discharge pathways to improve functional outcomes and reduce readmissions.
Conclusion
Between 2018 and 2024, a German highest-level trauma centre demonstrated that elderly patients with head and neck trauma require tailored diagnostic and therapeutic pathways that account for frailty, comorbidity, and anticoagulation status. By refining imaging protocols, enhancing multidisciplinary collaboration, and prioritizing functional recovery, centres can improve outcomes for this growing patient population while optimizing resource use in a strained healthcare environment.
