The changing face of major trauma in the UK

Abstract

AimMajor trauma (MT) has traditionally been viewed as a disease of young men caused by high-energy transfer mechanisms of injury, which has been reflected in the configuration of MT services. With ageing populations in Western societies, it is anticipated that the elderly will comprise an increasing proportion of the MT workload. The aim of this study was to describe changes in the demographics of MT in a developed Western health system over the last 20 years.MethodsThe Trauma Audit Research Network (TARN) database was interrogated to identify all cases of MT (injury severity score >15) between 1990 and the end of 2013. Age at presentation, gender, mechanism of injury and use of CT were recorded. For convenience, cases were categorised by age groups of 25 years and by common mechanisms of injury. Longitudinal changes each year were recorded.ResultsProfound changes in the demographics of recorded MT were observed. In 1990, the mean age of MT patients within the TARN database was 36.1, the largest age group suffering MT was 0–24 years (39.3%), the most common causative mechanism was road traffic collision (59.1%), 72.7% were male and 33.6% underwent CT. By 2013, mean age had increased to 53.8 years, the single largest age group was 25–50 years (27.1%), closely followed by those >75 years (26.9%), the most common mechanism was low falls (39.1%), 68.3% were male and 86.8% underwent CT.ConclusionsThis study suggests that the MT population identified in the UK is becoming more elderly, and the predominant mechanism that precipitates MT is a fall from <2 m. Significant improvements in outcomes from MT may be expected if services targeting the specific needs of the elderly are developed within MT centres.

Major incident triage: Derivation and comparative analysis of the Modified Physiological Triage Tool (MPTT)

“…26 Whilst the MPTT has demonstrated good performance at predicting need for lifesaving intervention within our cohort, and may be likely to do so in the context of terrorist atrocities on civilians, its performance may not easily translate to a civilian major incident if the mechanism of injury is predominantly blunt trauma. 25 Closely linked with the mechanism of injury experienced on the battlefield is the relatively low age (median 24 years, mean 26.2 years) and the low frequency of females injured within our dataset (n=60, 1.6%). Within a UK civilian trauma context it has been acknowledged that the mean age of patients has increased over the last three decades and in 2013 was 53.8 years.…”

“…5 Our dataset demonstrates a high proportion of priority one patients (n=1755, 47.8%), most of whom suffered blast and ballistic injury (n=3268, 89.0%). 25 Over the last decade several high profile terrorist atrocities have occurred across Europe, including a number of marauding terrorist firearm attacks, using high velocity weapons and improvised explosive devices akin to that seen in the military setting. 26 Whilst the MPTT has demonstrated good performance at predicting need for lifesaving intervention within our cohort, and may be likely to do so in the context of terrorist atrocities on civilians, its performance may not easily translate to a civilian major incident if the mechanism of injury is predominantly blunt trauma.…”

“…Within a UK civilian trauma context it has been acknowledged that the mean age of patients has increased over the last three decades and in 2013 was 53.8 years. 25 We also recognise that our cohort of predominantly young males are likely to have limited medical comorbidities when compared to the population as a whole, and therefore the physiology with which we have derived the MPTT is likely to not be fully representative of the whole population. Whilst this is not specific to the major incident environment, it is likely that it will be relevant and these factors are acknowledged as limitations to our study and must be explored before the MPTT can be recommended for use in a civilian context.…”

Injury mortality in Sweden; changes over time and the effect of age and injury mechanism

“…Injury mortality in elderly is a growing problem in the western world with an aging population (4,(27)(28)(29). The aging population causes an increased burden on the healthcare system (27,28).…”

“…The aging population causes an increased burden on the healthcare system (27,28). Injury mortality seems to increase with older age (14-18) but the reason for the higher mortality in older ages is complex, it does not seem to be an effect of nor age or comorbidities alone (29).…”