Sacral Fractures Are Increasing in Frequency, with Females and Falls Comprising the Majority: A NEISS Cross-Sectional Study from 2003 to 2022

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.