Background The burden of frailty on older people is identifiable by its adverse effect on mortality, morbidity and long term functional and health outcomes. In patients suffering from a traumatic injury there is increasing evidence that it is frailty rather than age that impacts greatest on these outcomes and that early identification can guide frailty specific care. The aim of this study was to evaluate the feasibility of nurse-led assessment of frailty in older trauma patients in the ED in patients admitted to major trauma centres. Methods Patients age 65 years and over attending the Emergency Departments (ED) of five Major Trauma Centres following traumatic injury were enrolled between June 2019 and March 2020. Patients were assessed for frailty whilst in the ED using three different screening tools (Clinical Frailty Scale [CFS], Program of Research to Integrate Services for the Maintenance of Autonomy 7 [PRIMSA7], and the Trauma Specific Frailty Index [TSFI]) to compare feasibility and accuracy. Accuracy was determined by agreement with geriatrician assessment of frailty. The primary outcome was identification of frailty in the ED using three different assessment tools. Results We included 372 patients whose median age was 80, 53.8% of whom were female. The most common mechanism of injury was fall from less than 2 m followed by falls greater than 2 m. Completion rates for the tools were variable, 31.9% for TSFI, compared to 93% with PRISMA7 and 98.9% with the CFS. There was substantial agreement when using CFS between nurse defined frailty and geriatrician defined frailty. Agreement was moderate using PRISMA7 and slight using TSFI. Conclusions This prospective study has demonstrated that screening for frailty in older major trauma patients within the Emergency Department is feasible and accurate using CFS. Trial registration ISRCTN, ISRCTN10671514. Registered 22 October 2019

There is literature demonstrating that the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine has analgesic properties that can be used as an adjuvant to opiates for pain relief in multiple various conditions and pain states. However, there is a lack of published information on ketamine used in persons with sickle cell disease in acute pain crises. The Virginia Commonwealth University Palliative Care team was consulted on a 38-year-old African American female with sickle cell thalassemia in severe acute pain crisis overlying chronic pain related to her disease. Pain control was unable to be achieved with escalating doses of opiates and other adjuvant medications. The patient responded well to an intravenous test dose of ketamine and was subsequently placed on an oral regimen of ketamine in addition to opiates. In the 24-hour period following ketamine initiation, the patient's pain was able to be controlled on decreased amounts of opiates. She was eventually transitioned to an oral opiate and ketamine regimen, which allowed her to be discharged home with pain levels close to her baseline and the ability to function and perform all activities of daily living.

Although median pain scores improved at follow-up, less than half of patients were responders. Patients with AC had a significantly better response rate than NED patients and a lower pain score than NLLI patients at follow-up.

Background Knife-related violence is of growing concern in the UK. This study aims to investigate the impact of the COVID-19 pandemic on the frequency of penetrating injuries at a UK major trauma centre. Methods This was a retrospective study comparing the number of patients attending the emergency department of King’s College Hospital (KCH) with a penetrating injury (gunshot or stab wound) during the ‘pandemic year’ (1 March 2020–28 February 2021) compared with the equivalent time period in the previous year. Penetrating injuries as a result of self-harm were excluded. The primary outcome was to assess whether there were any changes to the frequency of presentations during three periods of national lockdowns. Results Lockdown 1 showed a 48.45% reduction in presentations in the ‘pandemic year’ compared to the previous year, lockdown 2 showed a 31.25% reduction; however, lockdown 3 showed an 8.89% increase in the number of presentations. Conclusion Our findings suggest that despite the initial reduction in the number of presentations of penetrating injury during lockdown 1, this returned to normal levels by lockdown 3. Further research is required to understand the effects of government-imposed restrictions on interpersonal violence and identify appropriate methods of outreach prevention during a pandemic.

The 9 th London Trauma Conference (#LTC2015) and London Cardiac Arrest Symposium (#LCAS2015) built on the previous meetings with an emphasis on innovation, research, and enthusiasm for the medical care of major trauma, cardiac and critically ill patients. From the 8-11th December 2015 delegates from over 20 countries attended The Royal Geographical Society for the four days of the conference. The opening two days of the conference focussed on current issues in major trauma, with air ambulance and pre-hospital critical care on day three, and the London cardiac arrest symposium returning as the fourth and final day. Concurrent breakaway sessions ran alongside the main conference including; trauma haemorrhage research, paediatric trauma, and masterclasses on cardiac ultrasound and resuscitation, thoracotomy, REBOA, and an introduction to ECLS and ECMO. The major trauma programme consisted of two days of lectures, keynote lectures and short 'quickfire' sessions. Professor Tim Coats opened the conference by talking about the role of the highly performing trauma unit in trauma networks -outlining the problems of maintaining high levels of care in systems which increasingly bypass to major trauma centres but bring severely injured irregularly to trauma units. Professor Kjetil Søreide then addressed the topic of iatrogenesis in trauma, giving examples from different points in the patient pathway. The prevention of iatrogenesis is based on acceptance of it's presence and then promoting prevention with a culture of safety, training and focus on the team approach. Dr Matt Thomas finished up by summarising the landscape of research in trauma over the previous year, as well as outlining what can be expected in the year ahead. The following sessions approached key issues in neurotrauma, opened by a seasoned London Trauma Conference speaker Mr Mark Wilson. He spoke on current early neurological imaging, with mobile CT scanning already a reality in mainland Europe and the trialling of near infrared spectroscopy (NIRS) as a potential pre-hospital imaging modality. Professor Geoffrey Raisman followed with a fascinating talk on spinal cord regeneration, outlining how nerve regeneration to replace damaged portions has already been trialled with some success. He related a moving case where olfactory nerve fibres were used to repair spinal cord injury with one of the ultimate medical triumphs -making a paraplegic patient walk again. Professor Andrew Maas then lectured expertly on why he sees head injury as a silent epidemic with potentially life-changing consequences. Dr Markus Skrifvars closed the session with a sobering presentation on the link between alcohol consumption and the vast number of traumatic brain-injured patients that are intoxicated when they present. Lunch was followed by Professor Karim Brohi, who delivered a talk on the early immune response to trauma and novel potential approaches to ameliorate this genomic storm. Other speakers in the afternoon included Professor Marc Turner delivering his vision for the trauma ...