Author(s): Kennett A.; Mercer S.; Cromer D.
Source: Anaesthesia; Jan 2019; vol. 74 ; p. 27
Publication Date: Jan 2019
Publication Type(s): Conference Abstract
Available at Anaesthesia – from Wiley Online Library Full Collection
Abstract:Elderly trauma accounts for > 20% of UK major trauma [1]. In 2017, the Trauma Audit & Research Network (TARN) published a report into major trauma in older people with an Injury Severity Score (ISS) > 15 [2]. Key findings were that two distinct types of major trauma are seen: high-energy transfer trauma in younger patients and lower energy in the elderly where a fall of < 2 m was the most common mechanism. Older people were more likely to be injured indoors, presenting during daytime hours. Time to computed tomography (CT) of the head was 1.5 h longer than younger patients. This service evaluation reviews patients > 65-years old presenting at a major trauma centre in the North West England in 2017. Methods Institutional Clinical Audit Department permission was granted (CAMS 6455). A case note review was undertaken of all patients who were included in our TARN records who were > 65-years old, with an ISS > 15 who activated the Trauma Team. Results Total TARN cases for 2017 were 1075 with those > 65 years accounting for 411 (38.2%), 220 activated a trauma call and 131 cases of these had an ISS score of > 15. We analysed 127 cases, (77 men and 50 women) with a mean age of 76.7 years, range 65.1-99.4). Mechanisms of injury were blow (n = 4), crush (n = 1), fall < 2 m (n = 32), fall > 2 m (n = 67) and vehicle collision (n = 23). The 30-day mortality rate was 80%. Other selected results are listed in Table 1. Table 1 Selected results. (Table Presented) Discussion In 2017, patients > 65-years old accounted for 2/5 of patients on the TARN database in our institution. The most common mechanism was fall from > 2 m, which is in contrast to the national database (fall from < 2 m) [2]. Traumatic brain injury is recognised nationally as the commonest cause of death [2]. Despite half our patients presenting out of hours they all received consultant-delivered care with time to CT of < 45 min in over 4/5 of cases. An increased workload of elderly trauma may require an elderly medicine physician on the trauma team in the future.
Database: EMBASE