Age and the distribution of major injury across a national trauma system

Abstract

Background Trauma places a significant burden on healthcare services, and its management impacts greatly on the injured patient. The demographic of major trauma is changing as the population ages, increasingly unveiling gaps in processes of managing older patients. Key to improving patient care is the ability to characterise current patient distribution. Objectives There is no contemporary evidence available to characterise how age impacts on trauma patient distribution at a national level. Through an analysis of the Trauma Audit Research Network (TARN) database, we describe the nature of Major Trauma in England since the configuration of regional trauma networks, with focus on injury distribution, ultimate treating institution and any transfer in-between. Methods The TARN database was analysed for all patients presenting from April 2012 to the end of October 2017 in NHS England. Results About 307,307 patients were included, of which 63.8% presented directly to a non-specialist hospital (trauma unit (TU)). Fall from standing height in older patients, presenting and largely remaining in TUs, dominates the English trauma caseload. Contrary to perception, major trauma patients currently are being cared for in both specialist (major trauma centres (MTCs)) and non-specialist (TU) hospitals. Paediatric trauma accounts for <5% of trauma cases and is focussed on paediatric MTCs. Conclusions Within adult major trauma patients in England, mechanism of injury is dominated by low level falls, particularly in older people. These patients are predominately cared for in TUs. This work illustrates the reality of current care pathways for major trauma patients in England in the recently configured regional trauma networks.

Trauma system developments reduce mortality in hospitalized trauma patients in Al-Ain City, United Arab Emirates, despite increased severity of injury

“…The increased risk of falls in the geriatric population is related to multiple factors including gait imbalance, weak joints, and use of medications [25]. Falls caused almost 70% of geriatric injuries in the current study which is similar to findings from other studies [26,27]. The location of injury has significantly changed over time.…”

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“…Trauma systems are obliged to continuously improve quality and patient safety and in this respect epidemiological studies are important to identify high-risk populations which preventive measures can be directed towards [4,5] . Several mature trauma systems experience a demographic transition into older populations, and the impact of geriatric trauma is already showing [6][7][8][9] . Adaptation to ongoing changes in the trauma population is one of the major challenges for modern, evolving trauma systems [10] .…”

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“…For example, in England, services for treating injured survivors were reconfigured in 2012 with the establishment of Major Trauma Centres (MTCs). These MTCs provide [ 13 ] care for survivors with at least moderately severe injuries (Injury severity score (ISS) ≥ 9), which are most commonly caused by falls, road traffic collisions, assaults, and penetrating injuries [ 14 , 15 ] and currently report survival rates of over 90% [ 15 ].…”