Sacral Fractures Are Increasing in Frequency, with Females and Falls Comprising the Majority: A NEISS Cross-Sectional Study from 2003 to 2022
4 affiliations
- 1College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- 2Department of Orthopedic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH 45409, USA
- 3Department of Neurosurgery, Duke University, Durham, NC 27710, USA
- 4Department of Orthopedic Surgery, Duke University, Durham, NC 27710, USA
Abstract
Background/Objectives: Sacral fractures are clinically important injuries that may be occult at presentation and may occur after both low-energy falls and higher-energy trauma. National emergency department data describing temporal trends, mechanisms, associated fractures, and disposition remain limited. Methods: A retrospective cross-sectional study was performed using the National Electronic Injury Surveillance System from 2003 to 2022. Sacral fracture emergency department visits were identified using diagnosis and body-part codes with narrative confirmation of sacral involvement. National estimates were generated using NEISS survey weights. The primary outcome was population-based ED visits per 100,000 United States population, overall and stratified by sex. Secondary outcomes included mechanism category, injury location, concurrent vertebral or hip fracture, and emergency department disposition. Results: A total of 1747 sacral fracture emergency department visits were identified, representing an estimated 72,215 national visits. Low-energy falls accounted for 67.9% of presentations. Mean age was 61.1 years, and 70.0% of patients were female. Injuries most commonly occurred at home (50.5%). Annual ED visit rate increased from 2003 to 2022, with a steeper rise among females than males. Disposition varied by mechanism. Motor vehicle or transport-related injuries had the highest admission or hospitalization proportion (54.6%), whereas high-energy falls had the highest treated-and-released proportion (62.0%). In survey-aware multinomial regression, increasing age was associated with lower odds of high-energy falls, motor vehicle or transport injuries, and non-fall other injuries compared with low-energy falls. Male sex was associated with motor vehicle or transport mechanism. Conclusions: National emergency department presentations for sacral fractures increased from 2003 to 2022 and were dominated by low-energy falls among older female patients. However, transport-related and higher-energy mechanisms showed distinct demographic and disposition patterns. These findings supported trauma-system awareness, mechanism-informed co-injury screening, and orthopedic or spine referral pathways for sacral fracture presentations.
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BibTeX
@article{ononogbuuche2026sacral,
title = {{Sacral Fractures Are Increasing in Frequency, with Females and Falls Comprising the Majority: A NEISS Cross-Sectional Study from 2003 to 2022}},
author = {Favour C. Ononogbu-Uche and William J. Bohne and Arnav Sharma and Arianna Brinkley and Andrii A. Del Rosario and Karim Akl and Richard Jiang and Harry Wang and Andrew W. Froehle and Allen A. Champagne and Ethan Cottrill and William Richardson and Malcolm DeBaun and Norah A. Foster and Muhammad M. Abd-El-Barr},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207895},
url = {https://www.mdpi.com/2077-0383/15/20/7895},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Sacral Fractures Are Increasing in Frequency, with Females and Falls Comprising the Majority: A NEISS Cross-Sectional Study from 2003 to 2022
AU - Favour C. Ononogbu-Uche
AU - William J. Bohne
AU - Arnav Sharma
AU - Arianna Brinkley
AU - Andrii A. Del Rosario
AU - Karim Akl
AU - Richard Jiang
AU - Harry Wang
AU - Andrew W. Froehle
AU - Allen A. Champagne
AU - Ethan Cottrill
AU - William Richardson
AU - Malcolm DeBaun
AU - Norah A. Foster
AU - Muhammad M. Abd-El-Barr
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207895
UR - https://www.mdpi.com/2077-0383/15/20/7895
AB - Background/Objectives: Sacral fractures are clinically important injuries that may be occult at presentation and may occur after both low-energy falls and higher-energy trauma. National emergency department data describing temporal trends, mechanisms, associated fractures, and disposition remain limited. Methods: A retrospective cross-sectional study was performed using the National Electronic Injury Surveillance System from 2003 to 2022. Sacral fracture emergency department visits were identified using diagnosis and body-part codes with narrative confirmation of sacral involvement. National estimates were generated using NEISS survey weights. The primary outcome was population-based ED visits per 100,000 United States population, overall and stratified by sex. Secondary outcomes included mechanism category, injury location, concurrent vertebral or hip fracture, and emergency department disposition. Results: A total of 1747 sacral fracture emergency department visits were identified, representing an estimated 72,215 national visits. Low-energy falls accounted for 67.9% of presentations. Mean age was 61.1 years, and 70.0% of patients were female. Injuries most commonly occurred at home (50.5%). Annual ED visit rate increased from 2003 to 2022, with a steeper rise among females than males. Disposition varied by mechanism. Motor vehicle or transport-related injuries had the highest admission or hospitalization proportion (54.6%), whereas high-energy falls had the highest treated-and-released proportion (62.0%). In survey-aware multinomial regression, increasing age was associated with lower odds of high-energy falls, motor vehicle or transport injuries, and non-fall other injuries compared with low-energy falls. Male sex was associated with motor vehicle or transport mechanism. Conclusions: National emergency department presentations for sacral fractures increased from 2003 to 2022 and were dominated by low-energy falls among older female patients. However, transport-related and higher-energy mechanisms showed distinct demographic and disposition patterns. These findings supported trauma-system awareness, mechanism-informed co-injury screening, and orthopedic or spine referral pathways for sacral fracture presentations.
SN - 2077-0383
ER -