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Objectives and questions: The prevalence of geriatric trauma has increased steadily in recent years, challenging the validity of traditional triage criteria in prehospital and early in-hospital trauma care. In older patients, a systolic blood pressure (SBP) threshold of 90 mmHg may underestimate comprised tissue and organ perfusion due to comorbidities and polypharmacy. Using data from the German TraumaRegister DGU^® (TR-DGU), this study investigated associations between currently applied hypotension criteria and adverse outcomes in geriatric trauma patients and evaluated whether SBP thresholds for defining hypotension should be reconsidered in this population.

Material and methods: A retrospective analysis of the TR-DGU was conducted. Patients aged ≥ 20 years who sustained severe injuries (AIS ≥ 3) between January 2015 and December 2023 were included. Patient demographics, injury patterns, trauma severity, treatment characteristics, and clinical outcomes were analyzed using multivariate logistic regression models. Patients were stratified in four groups according to their age: 20 – 59, 60 – 69, 70 – 79, ≥ 80 years.

Results: A total of 158,833 patients were included in this study. With increasing age, the proportion of traffic accidents decreased, whereas low-level falls became more prevalent. Chest trauma was more common in younger patients, while the incidence of head injuries increased markedly with age. Multivariate logistic regression demonstrated a significant increase in mortality associated with advancing age (≥ 70 years) and with an SBP ≤ 120 mmHg on admission. In patients aged ≥ 70 years, an SBP ≤ 120 mmHg was associated with up to a 2.4-fold increased risk of mortality. The most clinically relevant increase in mortality was observed in the age group of ≥ 80 when the SBP dropped below 110 mmHg. For all age groups, an SBP ≥ 120 mmHg was associated with the lowest odds ratio for mortality.

Discussion and conclusions: This study indicates that hypotension thresholds in geriatric trauma patients may require redefinition. An admission SBP ≤ 120 mmHg was associated with worse outcomes and substantially increased mortality, particularly in patients aged ≥ 70 years. These findings suggest that the traditional SBP threshold of 90 mmHg may be inadequate for this population. In the absence of indications for permissive hypotension, maintaining an SBP ≥ 120 mmHg may represent a more appropriate hemodynamic target in geriatric trauma care.