2011 Review of the requirement and impact of the medicine for the Elderly Major Trauma Service in South-East Scotland

Abstract

Abstract Introduction It is well established that older adults with hip fracture benefit from comprehensive geriatric assessment (CGA), but there is less evidence for its use in major trauma. Since 2012 Major Trauma Centres (MTCs) have opened across the UK, with varying access to CGA. We report the requirement and impact of CGA in a MTC in its first year of opening. Methods We reviewed all adult patients admitted under the South-East Scotland MTC included in the Scottish Trauma Audit Group (STAG) database from 1st November 2021 – 31st October 2022. We compared: patients under 65y, patients ≥65y who did not undergo CGA, and patients ≥65y who underwent CGA. Outcomes were: review by ED consultant within one hour of presentation, trauma team activation, injury severity score (ISS), CGA within 7 days when CFS≥5, and mortality at 30 days. Results 1323 patients were identified (mean age 63.7y, SD20.9): <65y (n=690, 45.5y, SD14.0), ≥65y without CGA (n=401, 77.2y, SD8.2), and ≥65y with CGA (n=289, 84.6y, SD 7.3). The commonest mechanism of injury in all three groups was fall from standing height (29.1%, 59.6%, and 73.4% respectively). ED consultant review within 1 hour occurred in 37%, 25% and 18% of cases, with trauma team activation occurring in 32%, 18% and 7%. Average ISS were: 13, 12 and 11, and commonest sites of injury in those over 65 were external (e.g. skin), chest and limb. CGA was undertaken within 7 days in 95.1% of those with a documented CFS≥5. Mortality at 30 days was 2.9%, 12% and 8%. Conclusions A fifth of patients admitted to our MTC in the first year were older adults with CFS≥5. These patients were under-triaged at several stages despite comparable average ISS across groups. CGA may reduce 30-day mortality. We recommend further research into the benefit of CGA within MTCs.