Care of the older trauma patient following low-energy transfer trauma—highlighting a research void

Abstract

Background in high-income countries trauma patients are becoming older, more likely to have comorbidities, and are being injured by low-energy mechanisms. This systematic review investigates the association between higher-level trauma centre care and outcomes of adult patients who were admitted to hospital due to injuries sustained following low-energy trauma. Methods a systematic review was conducted in January 2021. Studies were eligible if they reported outcomes in adults admitted to hospital due to low-energy trauma. In the presence of study heterogeneity, a narrative synthesis was pre-specified. Results three studies were included from 2,898 unique records. The studies’ risk of bias was moderate-to-serious. All studies compared outcomes in trauma centres verified by the American College of Surgeons in the USA. The mean/median ages of patients in the studies were 73.4, 74.5 and 80 years. The studies reported divergent results. One demonstrated improved outcomes in level 3 or 4 trauma centres (Observed: Expected Mortality 0.973, 95% CI: 0.971–0.975), one demonstrated improved outcomes in level 1 trauma centres (Adjusted Odds Ratio 0.71, 95% CI: 0.56–0.91), and one demonstrated no difference between level 1 or 2 and level 3 or 4 trauma centre care (adjusted odds ratio 0.91, 95% CI: 0.80–1.04). Conclusions the few relevant studies identified provided discordant evidence for the value of major trauma centre care following low-energy trauma. The main implication of this review is the paucity of high-quality research into the optimum care of patients injured in low-energy trauma. Further studies into triage, interventions and research methodology are required.

Using home monitoring technology to study the effects of traumatic brain injury in older multimorbid adults

“…8 Despite this older adult are underrepresented in TBI studies. 9,10 Therefore, much is assumed, but little is known about how TBI affects this population. 10 It is increasingly apparent that age alone is not synonymous with poor outcomes and factors such as pre-morbid multimorbidity and frailty influence recovery.…”

“…The prevalence of traumatic brain injury (TBI) among older adults is increasing faster than other age groups, primarily due to falls 8 . Despite this older adult are underrepresented in TBI studies 9,10 . Therefore, much is assumed, but little is known about how TBI affects this population 10 .…”