Silver Trauma in a Major Trauma Centre - A Service Review for 2017

Introduction: Elderly trauma (defined as > 65 years of age) now accounts for more than 20% of UK major trauma. There is an increase in the proportion of patients with major trauma aged 75 years or above, from 8.1% in 1990 to 26.9% in 2013. Older patients managed at trauma centres that treat a higher proportion of older people with injury have been shown to have lower in-hospital mortality rates. Late identification of injury has a number of adverse consequences; such as less involvement of senior medical staff, longer times to investigation and longer times to treatment. This service evaluation reviews patients > 65 years old presenting at a Major Trauma Centre in the North West of England in 2017. Methods: Permission was granted by the Clinical Audit Department (CAMS 6455) at our institution. 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: Of the 127 cases analysed the mean age was 76.7 (range 65.1 - 99.4) with a median of 75.5. There were 77 Male patients and 50 Females and 44 recorded 3 or co-morbidities on arrival with 51 recording 3 or more medications. The trauma team leader was a consultant in all cases with 65 patients arriving out of normal working hours (between 1800 and 0800). There were 11 patients on a prescription of Warfarin (Octoplas was given to 4 of them) and 7 Patients on Novel Anticoagulants (Apixaban 5, Rivaroxaban 1, Dabigatram 1. Twenty-three patients died within 30 days of injury. Conclusion: In 2017, patients ≥ 65 years old accounted for 38.2% of patients on the TARN database. Patients ≥ 65 years old with an injury severity score ≥ 15 accounted for 19.5% of cases. The most common mechanism was actually a fall from > 2 meters which is in contrast to the national TARN database review which quoted a fall from < 2 meters. The elderly may have significant comorbidities and so previous lessons learnt from the Defence Medical Services are not always appropriate.