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Original Investigation
June 15, 2017

Recreational Activity and Facial Trauma Among Older Adults

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
  • 2Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
  • 3Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
  • 4Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark
  • 5Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark
  • 6Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark
  • 7Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
  • 8Division of Otolaryngology, John Dingell Veterans Affairs Medical Center, Detroit, Michigan
JAMA Facial Plast Surg. Published online June 15, 2017. doi:10.1001/jamafacial.2017.0332
Key Points

Question  What are the incidence and characteristics of recreational activity-associated facial fractures among elderly Americans?

Findings  In this analysis, which uses the National Electronic Injury Surveillance System for facial fractures from recreational activities, there were 20 519 emergency department visits for recreational activity–associated facial fractures among adults 55 years of age or older. The annual incidence of facial fractures from recreational activities increased by 45.3% from 2011 through 2015; bicycling and team sports were the most common activities involved, and men were more likely than women to sustain orbital and mandible fractures.

Meaning  These findings offer areas for targeted prevention and provide valuable information for patient counseling.

Abstract

Importance  As the US population ages, public health agencies have released guidelines encouraging aerobic activity and muscle-strengthening exercises among older individuals. Facial trauma from such activities among elderly individuals has long been underappreciated.

Objectives  To evaluate the incidence of recreational activity–associated facial fractures among older adults and to further delineate injury characteristics including demographics, fracture location, and specific activities.

Design, Setting, and Participants  The National Electronic Injury Surveillance System was used to collect data on emergency department visits from January 1, 2011, to December 31, 2015, for individuals 55 years of age or older who sustained facial fractures from recreational activities. Individual entries were evaluated for activity code, fracture site, and demographics. Weighting data were used to extrapolate national incidence.

Main Outcomes and Measures  Incidence and location of facial fractures and associated recreational activity.

Results  During the study period, there were 20 519 emergency department visits for recreational activity–associated facial fractures among adults 55 years of age or older (8107 women and 12 412 men; mean [SD] age, 66.5 [9.1] years). The annual incidence of facial fractures increased by 45.3% from 2011 (n = 3174) through 2015 (n = 4612). Bicycling (26.6%), team sports (15.4%), outdoor activities (10.1%), and gardening (9.5%) were the most common causes of facial fractures. Walking and jogging caused 5.5% of fractures. In cases specifying site of fracture, nasal (65.4%) and orbital (14.1%) fractures were the most common. A greater proportion of men than women sustained bicycle-associated fractures (35.7% vs 14.9%; P = 3.1056 × 10−170), while more women than men sustained fractures associated with gardening (15.5% vs 6.1%; P = 2.1029 × 10−97), outdoor activities (14.6% vs 7.7%; P = 4.3156 × 10−50), and gym exercise (7.7% vs 1.3%; P = 3.0281 × 10−114). Men harbored a greater likelihood than women of orbital (14.9% vs 12.8%; P = 6.1468 × 10−5) and mandible fractures (9.3% vs 2.0%; P = 9.3760 × 10−64). Walking and jogging and gardening comprised a greater proportion of injuries in older cohorts.

Conclusions and Relevance  Facial fractures sustained from recreational activity increased by 45.3% during a 5-year period among older adults. Although bicycling was the most common activity facilitating these injuries, many other pursuits represent areas of concern. Nasal fractures predominated, although orbital fractures increased with age. These findings offer areas for targeted prevention and provide valuable information for patient counseling. Furthermore, initiatives encouraging greater activity among this population may need to be accompanied by guidelines for injury prevention.

Level of Evidence  NA.

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