Conventional Trauma Metrics Underestimate Risk After Mower- and Tractor-Related Injuries in Older Adults.

Standard trauma metrics may underestimate risk in geriatric patients sustaining mower- and tractor-related injuries. A retrospective review was performed of adult trauma patients presenting with mower- or tractor-related injuries at three rural trauma centers from 2020-2024. Statistical analysis included chi-square and Mann-Whitney U tests. Of 176 patients, 94 (53.4%) were geriatric. Despite similar injury severity scores (ISS) and significantly lower rates of elevated shock index (SI >1: 0.7% vs. 6.7%, p=0.013), geriatric patients experienced nearly nine times the odds of mortality (6.9% vs. 0.8%, OR=8.889, p = 0.013), longer hospital stays (median 4 vs. 2 days, p = 0.002), and were significantly less likely to be discharged home (59.6% vs. 82.9%, p = 0.001). These findings suggest that ISS and elevated SI alone are insufficient to risk-stratify older patients after agricultural injury and that age-aware triage protocols and early multidisciplinary planning are warranted.