SP6.13 - Management of Older Major Trauma Patients: Impact of a dedicated guideline for facilitating older trauma care within a Pan London Trauma Network

Abstract

Abstract Background and Aim Older age trauma is an increasing challenge for trauma networks with many clinical protocols needing to adapt and reflect age-related changes in physiology and management. In 2018, our older trauma guidance was introduced into our trauma system to improve early recognition of injury, admission pathways, clinical management and outcomes for those aged ≥65yrs (LMTS Older Trauma Guidance). The aim of our study was to assess the impact of the guideline on our trauma processes and patient outcomes. Methods This retrospective analysis of TARN compared process and outcome data for patients aged ≥65yrs admitted to hospitals within the North East London and Essex Trauma Network, pre (01/01/2016-31/07/2018) and post (01/08/2018-31/07/2020) guidance introduction. The primary outcome was mortality at 30 days post injury. Results and conclusions There were 4317 patients pre and 3992 patient post guidance. Time to CT reduced on average by 57 minutes, Neurotrauma transfers decreased from 2116 patients to 1519 patients and more older patients were discharged for rehabilitation. Older trauma mortality reduced across the network post guidance (13.59% vs 10.64%). The greatest mortality reductions were seen in Trauma Units, (19.20% pre vs 6.99% post) with increasing benefit seen with advancing age: reduced 75-84 years by 2.20%; 85-94 years 2.41%; 95+ years by 7.44%. This analysis suggests that dedicated guidance highlighting the special needs and risk profiles of older trauma patients significantly improves processes and outcomes. Improvements in early assessment and time to imaging appear to result in enhanced survival. Further research at a system level is required.