Farm Animal-Related Trauma in an Aging Agricultural Workforce: A Multicenter Retrospective Cohort Study in Southern Appalachia

Agriculture remains one of the most hazardous industries in the United States, and livestock-related trauma represents an important source of injury in rural communities. As the agricultural workforce ages, understanding age-related differences in farm animal-related trauma has become increasingly important. Methods: We performed a retrospective multicenter cohort study of patients presenting with farm animal-related injuries to three regional trauma centers in Southern Appalachia between 2015 and 2024. Patients were stratified into geriatric (≥65 years) and non-geriatric (<65 years) groups. Demographics, comorbidities, injury characteristics, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) by body region, interventions, and clinical outcomes were compared. Results: A total of 333 patients were included, of whom 60 (18.0%) were geriatric. Older adults were significantly more likely to sustain cow/bull-related injuries, while younger patients more frequently sustained horse-related injuries. Geriatric patients demonstrated greater injury severity, higher rates of rib fractures, femur fractures, lower-extremity fractures, and flail chest. Older adults also had higher odds of ICU admission, transfusion, and were less likely to be discharged directly home. Discussion: Farm animal-related trauma in older adults is associated with greater injury severity, increased thoracic and lower-extremity injury burden, higher transfusion requirements, increased health care resource utilization, and lower rates of discharge home. As the agricultural workforce continues to age, targeted injury-prevention strategies and trauma-system planning efforts should focus on reducing the burden of livestock-related injury among older agricultural workers.