Pattern of injuries and management of adolescent trauma in a combined adult and paediatric major trauma centre in United Kingdom

Abstract

Background Major trauma is a leading cause of death and disability in 16–18-year olds in the UK. Since the launch of major trauma centres (MTCs) in 2012 in UK, survival rates have improved on the whole. The aim of this study was to look at the pathways of 16–18-year olds through one MTC and patterns of rehabilitation provision. Material and methods A retrospective case notes review of all trauma patients aged between 16 and 18 years admitted to one MTC between October 2012 and May 2018. Results One hundred forty-seven young people were identified. 67.3% were male with a mean age of 17.1 years. Motor vehicle accidents were the most common cause of injury (59.2%). Thirty-nine percent had a Glasgow Coma Scale at scene >13. Sixty-three percent were admitted to an adult intensive care unit (ICU), 5.4% to paediatric ICU and 31.3% directly to a ward. Admissions to rehabilitation ward came through adult services with no commissioned equivalent in those admitted to paediatrics. Mean length of stay was 18.1 days. 75.5% of patients were discharged home from the MTC. Discussion The majority of young people were admitted on to adult wards and were able to access commissioned services. However, such services do not provide for the specialist needs of young people, with no access to schooling or parent’s accommodation. Those who were admitted to children’s services missed out on commissioned rehabilitation pathways. Conclusion Young people of transition age often fall between services. For the first time, we illustrate injury patterns and the fragmented services seen in this vulnerable patient group.

Sports injuries: a 5-year review of admissions at a major trauma center in the United Kingdom

“…Furthermore, 92% of cases were discharged home and the median length of ICU stay was only 4 days. The overall good health outcomes can be attributed to (1) better-commissioned healthcare services for trauma-related injuries [11] such as trauma networks, air-ambulance services, specialist major trauma units, and RAAR services [19], and (2) a lower incidence of traumatic brain injuries, which are canonically associated with the worst health outcomes, compared to spinal and orthopedic injuries [21].…”

“…Sports groups with the most head injuries were bicycle and ball sports. The relatively low prevalence and relatively better GOS is attributed to widespread awareness regarding traumatic brain injury in the population, better preventive measures in sports activity, such as restricting dangerous moves, tackles, better training of players use of appropriate headgear, and better healthcare services for immediate management of head injuries [19,21]. Still, there is a need to sustain the present practices and further improve the services such as encouraging headgear use in motor sports, contact and ball sports, and bicycle sports (as has been in practice for routine motorcycle use) [13,26].…”

“…We conducted an unblinded study of the hospital records for all included cases as per recommended guidelines [18] and extracted the following demographic, injury-related, hospital episode-related, and health outcome-related data: age, sex, mechanism of injury, initial Glasgow Coma Scale (GCS; as recorded by first responders), ISS [19], length of hospital and intensive care unit (ICU) stay (days), rapid access acute rehabilitation (RAAR) ward stay, the pattern of injuries (according to the affected body regions), number of operations required, Glasgow Outcome Scale (GOS) and discharge destination. GOS at discharge was used as a primary outcome measure and the length of hospital stay as a secondary outcome measure.…”

Psychological and psychosocial aspects of major trauma care in the United Kingdom: A scoping review of primary research

“…The scoping review also identified that some types of major trauma injury had more established and integrated pathways whilst others were underserved. [31][32][33][34][35][36][37][38]49,50 In summary, there is inherent inequity across major trauma care pathways that likely result in health inequality following major trauma, and which may be amplified by existing health and social inequalities. The NHS standard contract for major trauma care providers advocates for holistic trauma care that includes coordination of immediate and ongoing care, provision of information about major trauma care pathways, signposting to voluntary and/or non-government support services that can assist with psychological and social impacts of major trauma as well as supporting family members and carers during and after admission.…”

“…traumatic brain injury, spinal cord injury) than others (musculoskeletal injury). 35,37 Gaps were also noted in children's rehabilitation services 36 and in neurorehabilitation services for children under 4 years. 38 In addition, it was found that children presenting with injuries caused by suspected child abuse were less likely to trigger a major trauma alert, be taken to a major trauma centre and receive timely intervention despite having more serious injuries.…”