Between 1 January 2011 and 31 December 2011 (the 2011 period), 178 patients were recorded in the TraumaRegister DGU database. Of these, 43 were transferred patients and therefore excluded from the analysis. In the period between 1 January 2021 and 31 December 2021 (the 2021 period), a total of 93 patients were recorded, of whom 14 were transferred (see Fig. 1). Thus the patient population under consideration in this study consisted of 214 patients (135 in the 2011 period and 79 in the 2021 period). The data for age, gender, admission time, ISS, NISS, length of hospital stay, duration of intensive care and injury pattern were fully complete. The data was 98.1% complete for the American Society of Anesthesiologists (ASA) score, 96.3% complete for the duration of ventilation, 97.2% complete for the outcome, 99.5% complete for the condition at discharge, and 99.1% complete for the accident type.

provides an overview of the study population, including the division into the subgroups investigated

The number of patients decreased during the study period, from 135 in 2011 to 79 in 2021. Concurrently, the proportion of geriatric patients (aged 65 years or older) increased, from 30.37% in 2011 to 40.51% in 2021. A notable increase in age was observed over the course of the study (p-value: 0.018). The mean age increased from 47.73 years in 2011 to 55.92 years in 2021, indicating that the average age of patients in both study periods was significantly higher than the national average and the average age in Mecklenburg-Vorpommern. Furthermore, the proportion of geriatric patients was higher than that observed in the overall German and Mecklenburg-Vorpommern populations (see Table 1). This increase was disproportionate in relation to the total population during the study period.

Additionally, there was an observed increase in the proportion of male patients. In 2011, 67.41% of patients were male, whereas in 2021 this percentage had risen to 81.01%. This indicates that the proportion of male patients was greater than the proportion of males in the overall population of Germany and Mecklenburg-Vorpommern (see Table 1). Moreover, this increase was disproportionate when compared to the total population. Furthermore, the severity of injury, as indicated by the Injury Severity Score (ISS) and the New Injury Severity Score (NISS), increased significantly over the observation period (see Table 2). The duration of mechanical ventilation increased significantly (p-value: 0.004; 2011: 76.80 h; 2021: 111.41 h) as well. No significant differences were observed between the two study groups with regard to pre-existing conditions (ASA score; p-value: 0.973), duration of intensive care (p-value: 0.115) and length of hospital stay (p-value: 0.125).

A significant increase in ISS and NISS was observed in the geriatric patient population, as well as in the overall patient population (see Table 2). No significant differences were observed between the two study periods with regard to ASA score (p-value: 0.119), admission time (p-value: 0.377), age (p-value: 0.585), duration of intensive care therapy (p-value: 0.862), length of hospitalisation (p-value: 0.410) or duration of mechanical ventilation (p-value: 0.646) within this subgroup. In the subgroup of geriatric polytrauma patients, a significant reduction in the duration of intensive care (p-value: 0.007), the duration of mechanical ventilation (p-value: 0.011) and the total length of hospitalisation (p-value: 0.030) was observed (see Table 3).

A comparison of the entire patient population revealed a statistically significant decrease (p-value: 0.114) in the proportion of patients discharged to home in 2021 (53.16%) compared to 2011 (62.22%), while hospital mortality increased (2011: 9.63%; 2021: 21.52%). The proportion of patients transferred to another hospital (2011: 5.19%; 2021: 3.80%) or a rehabilitation clinic (2011: 20.00%; 2021: 18.99%) remained relatively constant.

A significant increase in hospital mortality was observed in geriatric patients as well as in the overall collective (2011: 14.63%; 2021: 40.63%). There has been a decline in the number of discharges to the patients’ place of residence (2011: 53.66%; 2021: 43.75%) and transfers to a rehabilitation clinic (2011: 26.83%; 2021: 6.25%), as evidenced by a p-value of 0.097. In contrast, a notable increase was observed in discharges to home for geriatric polytrauma patients (2011: 26.32%; 2021: 46.67%), accompanied by a pronounced decline in transfers to rehabilitation facilities (2011: 47.37%; 2021: 3.33%) (p-value: 0.871). The in-hospital mortality rate for geriatric polytrauma patients increased significantly, from 26.32% in 2011 to 43.33% in 2021. The overall hospital mortality rate increased significantly, from 9.63% in 2011 to 21.52% in 2021. The greatest increase was observed in the geriatric age group, which also exhibited the highest mortality rate in both periods (see Table 4).

With regard to the condition of patients upon discharge, there was a notable increase in the number of cases where patients were discharged from hospital in a poor condition, defined as cases where patients were severely disabled or unresponsive. Conversely, the proportion of patients who were well recovered or moderately disabled decreased during the study period (see Table 5).

With regard to the type of accident, the overall distribution remained approximately constant between the two study periods. The distribution of accident types among geriatric patients also remained almost unchanged. There was a slight tendency towards traffic accidents and falls from a height of at least three metres, as well as a decrease in falls from low heights. In the subgroup of polytraumatised geriatric patients, there was an increase in traffic accidents (2011: 15.79%; 2021: 30%), while there was a tendency for falls to decrease.

The highest proportion of road traffic accidents occurred among the 19–64 age group in 2011. This was also observed in the subgroup of polytrauma patients. In contrast, the highest proportion of road traffic accidents was observed among paediatric patients in 2021 (see Table 6). Moreover, the number of road traffic accidents involving members of the geriatric population rose significantly. Conversely, the proportion of falls from low heights was highest in the geriatric group, a finding that was also observed in the polytrauma patients. Nevertheless, the incidence of falls from low heights declined among the geriatric patient cohort, both in the general population and in the polytraumatised population.

The data revealed a significant increase in the prevalence of thoracic injuries, from 36.30% in 2011 to 55.70% in 2021. The results of the chi-square tests for the parameters outcome (p-value: 0.114), accident type (p-value: 0.531) and injury pattern were, with the exception of thoracic injuries, not statistically significant.