UK Major Trauma Centre Research Articles

SP6.14 - The Burden of Penetrating Junctional Injuries in a UK Major Trauma Centre: a Retrospective Cohort Study

Abstract Background Junctional injuries occur at the join of ‘anatomically distinct zones’. The emergence of junctional injuries in trauma care has been a consequence of recent battlefield casualties; accounting for 21% of potentially survivable deaths from haemorrhage. Although well described in military literature, there are no civilian studies into junctional injuries. This study aims to examine the epidemiology and resource burden of junctional penetrating injuries. Methods Retrospective study of adult and paediatric patients with penetrating injuries to a junctional zone presenting to an urban MTC in one year. Electronic patient records were searched and data on anatomical distribution of injury, imaging and theatre utilisation, inpatient stay, and discharge codes extracted. Discharge codes were referenced with the National Schedule of NHS costs to produce a cost. Results In 132 patients 92.4% (n=122) were male with median age 27.5 and in hospital mortality 1.6% (n=2). Saturday and Sunday were most frequent 37.9% (n=50) and 81.8% (n=108) attended after 1700 and before 0800. 37.9% (n=50) of injuries were buttock; 22% (n=29) neck; 18.9% (n=25) multiply-injured; 8.3% (n=11) axilla; 6.8% (n=9) diaphragm; and 6.1% (n=8) groin. Median Injury Severity Score (ISS) 8. 46.2% (n=61) underwent surgery; 50.8% (n=67) were admitted, 7.6% (n=10) to ITU. Median length of ward stay was 3 days. 15.9% (n=21) received blood products. The overall cost was £914,076. Conclusion Junctional injuries are a significant resource burden. Buttock wounds were the most common but had the lowest median ISS and cost. Diaphragmatic injuries appear distinct from junctional wounds in terms of ISS and cost, and may be separate to other junctional zones.

Characteristics of equestrian accidents and injuries leading to permanent medical impairment

BackgroundEquestrian sports, also referred to as equestrianism, is practiced all over the world and a popular leisure activity in Sweden. Equestrianism is the country’s second-largest youth sport, and previous studies indicate that accidents are common in equestrianism. However, few previous studies have examined acute equestrian injuries leading to permanent medical impairment (PMI).MethodsBy using nationwide insurance data comprising all injured equestrians registered in the Swedish Equestrian Federation, the aim was to analyse characteristics of equestrian accidents and particularly injuries leading to PMI, both in general and by age, gender, incident type, injury type and injured body region. Injury incidence and injuries leading to PMI were examined. All equestrians injured during 2017–2021 were included (n = 6,876), however, only injuries occurring in 2017 and 2018 were used to analyse the risk and the injury distribution of injuries leading to PMI. Injury incidence was calculated separately for males and females, as well as for different age groups, by dividing the number of insurance claims by the number of members multiplied by 1,000. Risk Ratio (RR) was calculated between gender. Pearson’s chi-squared test was used to analyse differences in distribution for categorical variables.ResultsThe majority of injuries affected females, correlating to approximately three times higher risk, compared to males. The age group 21–40 years were associated with the highest injury risk (14.26/1,000 registered riders). In total 12% of all injuries led to PMI. Injuries to the upper and lower extremities, along with fractures, had a higher risk of resulting in a PMI. The risk of injury leading to PMI was higher among riders over 20 years of age.ConclusionsThe fact that females face nearly three times the injury risk of males, and riders aged 21–40 had the highest injury risk while younger riders (Luke KL, McAdie T, Smith BP, Warren-Smith AK. New insights into ridden horse behaviour, horse welfare and horse-related safety. Appl Anim Behav Sci. 2022;246:105539.); (Havlik HS. Equestrian sport-related injuries: a review of current literature. Curr Sports Med Rep. 2010;9(5):299–302.); (Samuels K, Bettis A, Davenport DL, Bernard AC. Occupational vs. non-occupational equestrians: Differences in demographics and injury patterns. Injury. 2022;53(1):171–5.); (Gharooni A-A, Anwar F, Ramdeep R, Mee H. Severe equestrian injuries: A seven-year review of admissions to a UK major trauma centre. Trauma. 2023;25(1):41–7.); (Hasler RM, Gyssler L, Benneker L, Martinolli L, Schotzau A, Zimmermann H, et al. Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey. J Trauma Manag Outcomes. 2011;5:4.); (Meredith L, Brolin K, Ekman R, Thomson R. Analyses of injuries to equestrians in a Swedish district over a 16-year period. Translational Sports Med. 2019;2:270–8.) had a lower risk, indicates that preventive efforts should target both older and female riders. Injuries predominantly resulting in PMI involve upper and lower extremities, however, to prevent the most serious injuries significantly affecting a rider’s daily life, measures preventing head and spinal cord neck injuries, must be implemented. Head injures remain the most frequent, serious and most significant group of injuries to prevent and mitigate, within equestrian sports.

What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel

ObjectiveMajor trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). DesignOnline survey informed by the TDF and BCW. SettingUK trauma rehabilitation pathway. PopulationRehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78). AnalysisMean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies. ResultsMost respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). ‘Social/professional role and identity’, 'knowledge’ and ‘emotion’ (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including ‘seen as tick-box exercise’,‘not a priority’, lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs. ConclusionsAlthough rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.

242 The Burden of Penetrating Junctional Injuries in a UK Major Trauma Centre: A Retrospective Cohort Study

Abstract Aim Junctional injuries occur at the join of anatomically distinct zones. Recent battlefield casualties have shown junctional wounds account for 21% of potentially survivable deaths from haemorrhage. Although well studied in military literature, this is not the case in civilian setting. This paper aims to describe the civilian injury pattern to improve management and resource allocation. Method Retrospective study of all patients with penetrating injuries to a junctional zone presenting to an urban MTC in 2018. Patient records searched and data extracted on site of injury, management, and discharge code. Discharge codes were referenced with the National Schedule of NHS costs to produce a cost. Results 132 patients, 92.4% (n=122) male; median age 27.5; in hospital mortality 0.8% (n=1). 37.9% (n=50) of injuries were buttock; 22% (n=29) neck; 18.9% (n=25) multiply injured; 8.3% (n=11) axilla; 6.8% (n=9) diaphragm; and 6.1% (n=8) groin. Median Injury Severity Score (ISS) 8; median ISS multiply injured 29; diaphragm 16; groin 9; neck 5; axilla 4; buttock 4. 46.2% (n=61) underwent surgery; 50.8% (n=67) were admitted, 7.6% (n=10) to ITU. Median length of ward-stay 3 days. 15.9% (n=21) received blood products. The overall cost was £914,076; £6925/patient. Per patient for multiply injured £19,676; diaphragm £11,435; groin £7,483; axilla £3,553; neck £3,026; buttock £2,651. Conclusions Junctional injuries are a significant resource burden. Buttock wounds were the most common but had the lowest median ISS and cost. Diaphragmatic injuries appear distinct in terms of ISS and cost and should be considered as separate to other junctional wounds.

670 Investigating Delay During Presentation of Trauma in Young Adults: A UK Major Trauma Centre Retrospective Audit and a Systematic Review of the Literature

Abstract Introduction The current evidence in major trauma highlights that delays at multiple points along the patient care pathway, from incident to surgery, are associated with decreased survival. The aim of this audit was to assess performance across select delay parameters in juveniles aged 16-18 presenting to an adult MTC service following a systematic review of the literature. Method Patient records were interrogated between 1/10/2022-1/3/2023 and audited against 3 national standards: (1) Ambulance Response and Transfer (7 and 45mins respectively) (2) Tranexamic Acid infusion (<3hrs) and (3) CT scan (<60mins). A systematic search was also performed using EMBASE and OVID databases (01/01/2005-/01/11/2023). All studies assessing impact of time to theatre in patients with acute trauma were considered. Results 32 consecutive patients (3F:29M) (median 18 years[16-18]) were identified within the audit period. 40%(n=13) presented following penetrating injury and 35%(n=11) following a road traffic accident. Mean time from incident to admission was 83mins[±36], from incident to tranexamic acid infusion 50mins[±35], and from admission to CT Trauma Series 61mins[+/-100]. Median length of stay was 4 days [IQR=5]. The systematic search yielded 25 studies which were included in the analysis. An Incident2Surgery framework is presented which highlights key time-critical points for diagnosis and intervention. Conclusions Local compliance to national standards for tranexamic acid infusion in appropriate patients and performance of trauma CT was excellent with poor compliance to ambulance arrival and transfer time. The proposed Incident2Surgery framework could be incorporated into mortality prediction and audit tools and assist in the assessment of interventions.

DO ORTHOPAEDIC TRAUMA SOCIETY (OTS) SIMPLE FRACTURES RECEIVE A DIFFERENT STANDARD OF TREATMENT TO OTS COMPLEX FRACTURES?

IntroductionOpen fractures of the tibia are disabling injuries with a significant risk of deep infection. Treatment involves early antibiotic administration, early and aggressive surgical debridement, and may require complex soft tissue coverage techniques. The extent of disruption to the skin and soft-tissue envelope often varies, with ‘simple’ open fractures (defined by the Orthopaedic Trauma Society (OTS) open fracture severity classification) able to be closed primarily, whilst others may require shortening or soft-tissue reconstruction. This study aimed to determine whether OTS simple tibial open fractures received different rates of adequate debridement and plastic surgical presence at initial debridement, compared with OTS complex injuries, and whether rates of fracture-related infection, nonunion, or reoperation differed between the groups.Materials & MethodsA consecutive series of open tibia fractures managed at a tertiary UK Major Trauma Centre between January 2021 and November 2022 were included. Patient demographics, injury characteristics, timing of antibiotic delivery, timing and method of definitive fixation, and frequency of plastic surgical presence at initial debridement were retrospectively collected. The delivery of bone ends at initial debridement was used as a proxy for adequacy of surgical debridement. The primary outcome measure was rate of fracture-related infection, secondary outcomes included rates of reoperation, nonunion, and amputation. Chi2 Tests and independent samples T-tests were used to assess nominal and continuous outcomes respectively between simple and complex injuries. Ordinal data was assessed using nonparametric equivalent tests.Results79 patients with open fractures of the tibia were included. 70.8% of patients were male, with mean age 50.4 years (SD 19.2) and BMI 26.4 Kg/m2 (SD 6.0). Injuries were mostly sustained by low-energy falls (n = 28, 35.4%) and from road traffic accidents (n = 26, 32.9%). 27 (34.2%) were OTS simple open fractures. Simple open fractures were most commonly Gustillo-Anderson grade 1 (38.5%), or 2 (30.8%), whilst complex open fractures were mostly grade 3B (66.7%) (p < 0.001). Fracture-related infection rates in OTS simple and complex open fractures were 25.9% and 25.5% respectively (p = 0.967), and nonunion rates were 32% and 37.8% (p = 0.637). Primary amputation was less common in simple (0%) than in complex open fractures (20%, p = 0.012), there were no differences in delayed amputation rates (7.4% and 6% respectively, p = 0.811). Simple open fractures were less likely to have plastic surgeons present at initial debridement compared to complex open fractures (18.5% and 44%, p = 0.025), and less likely to have bone ends delivered through the skin at initial debridement (25.9% and 61.2%, p = 0.003). There were no differences in patient age, delays to antibiotic administration, or reoperation rates between OTS simple and OTS complex fractures (p > 0.05).ConclusionsDespite involving less significant soft tissue injury, OTS simple open tibia fractures had comparable deep infection and nonunion rates to complex fractures and received early plastic surgical input and adequate debridement less frequently. The severity of open fractures with less significant soft tissue injury may be underrecognized and therefore undertreated, although further prospective study is needed.

O65: Extremity Trauma in the UK (UK): Vascular Interventions and Surgery in Trauma Audit (VISTA)

Abstract Background Extremity injury is the commonest form of vascular trauma but currently there is no national surgical surveillance of operative management and amputation rates. Vascular injury impacts both the young and elderly, with time critical, trauma specific intervention key for limb salvage. Methods Subgroup analysis of a six-month multicentre, prospective audit of vascular injuries to examine procedures for extremity vascular trauma at 27 UK Major Trauma Centres conducted by the National Trauma Research & Innovation Collaborative and Vascular & Endovascular Research Network. Results There were 153 extremity vascular injuries (n=120 patients: 66 upper limb, 81 lower limb) with 92 primary interventions performed (n=86 open: primary repair, bypass or ligation vs. n=6 endovascular). The median age of operated patients was 36 (IQR: 22.5 - 52) years and 74% were male. 51% of injuries operated upon were secondary to blunt trauma with concomitant orthopaedic injury in 33%. Median time to intervention was 169 (IQR: 112 - 371) minutes with a consultant vascular surgeon present in 84% of cases. Overall, there were n=16 amputations: 7% primary and 11% secondary in operative cases. The median age for amputation was 41.5 (IQR: 36 - 52) years. Conclusion Extremity vascular interventions, regardless of aetiology, require national surveillance to assess outcomes and identify targets for improved limb salvage across all UK vascular and trauma networks.

O64: Aortic Trauma in the UK (UK): Vascular Interventions and Surgery in Trauma Audit (VISTA)

Abstract Background In the UK, the incidence, treatment strategies and clinical outcomes for aortic injury are unknown. Stent graft sizing can be challenging in the acute trauma setting which may increase the risk of stent graft complications. VISTA aimed to describe the UK burden and treatment of aortic trauma. Methods Subgroup analysis of a six-month multicentre, prospective audit of vascular injuries at 27 UK Major Trauma Centres by the National Trauma Research & Innovation Collaborative and Vascular & Endovascular Research Network. Results In total, 58 aortic injuries (43 thoracic, 15 abdominal) with 24 interventions (n=23 TEVAR) were analysed. The median age of TEVAR patients was 46 (IQR: 27 - 59) years and 92% were male. The median time to intervention was 288 (IQR: 208 - 722) minutes and 75% of cases were performed for grade 3 and 4 aortic injuries with one simultaneous carotid-subclavian bypass. A consultant vascular surgeon was documented as present in 75% of cases and the post-procedure mortality rate was 8%. Conclusion TEVARs performed for vascular trauma setting are currently excluded from the National Vascular Registry. UK centre performance, device surveillance and long-term outcomes for this patient cohort requires national monitoring to assure patient safety and drive care quality improvements.

Investigating the effects of frailty on six-month outcomes in older trauma patients admitted to UK major trauma centres: a multi-centre follow up study

BackgroundPre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission.MethodsThis was a multi-centre study of patients aged ≥ 65 years admitted to five MTCs. Data were collected via questionnaire at hospital discharge and six months later. The primary outcome was patient-reported HRQoL at follow up using Euroqol EQ5D-5 L visual analogue scale (VAS). Secondary outcomes included health status according to EQ5D dimensions and care requirements at follow up. Multivariable linear regression analysis was conducted to evaluate the association between predictor variables and EQ-5D-5 L VAS at follow up.ResultsFifty-four patients died in the follow up period, of which two-third (64%) had been categorised as frail pre-injury, compared to 21 (16%) of the 133 survivors. There was no difference in self-reported HRQoL between frail and not-frail patients at discharge (Mean EQ-VAS: Frail 55.8 vs. Not-frail 64.1, p = 0.137) however at follow-up HRQoL had improved for the not-frail group but deteriorated for frail patients (Mean EQ-VAS: Frail: 50.0 vs. Not-frail: 65.8, p = 0.009). There was a two-fold increase in poor quality of life at six months (VAS ≤ 50) for frail patients (Frail: 65% vs. Not-frail: 30% p < 0.009). Frailty (β-13.741 [95% CI -25.377, 2.105], p = 0.02), increased age (β -1.064 [95% CI [-1.705, -0.423] p = 0.00) and non-home discharge (β -12.017 [95% CI [118.403, 207.203], p = 0.04) were associated with worse HRQoL at follow up. Requirements for professional carers increased five-fold in frail patients at follow-up (Frail: 25% vs. Not-frail: 4%, p = 0.01).ConclusionsFrailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.

Group B or not group B? An association between ABO, early mortality, and organ dysfunction in major trauma patients with shock

BackgroundABO blood group alters coagulation profiles in the general population and may influence outcomes after trauma. The relationship between trauma-induced coagulopathy, severe injury with hemorrhagic shock, and survival with respect to ABO group is unknown. ObjectivesIn severe hemorrhagic trauma, we aimed to characterize the association of ABO group with admission coagulation profiles, mortality, and immune-mediated complications. MethodsClinical and laboratory variables were examined from severely injured adult patients enrolled in a perpetual observational cohort study at a UK Major Trauma Center. Univariate and multivariate analyses were performed to determine differences in clinical outcomes (mortality, organ dysfunction, and critical care support). In a shock subgroup, we performed an exploratory analysis of rotational thromboelastometry parameters and coagulation biomarkers. ResultsIn 1119 trauma patients, we found no difference in mortality between ABO groups. In patients with shock, 24-hour mortality was significantly lower in group B vs non-B groups (7% vs 16%, adjusted odds ratio [aOR], 0.19; P = .030), but there were increased rates of invasive ventilation (aOR, 3.34; P = .033), renal replacement therapy (aOR, 2.55; P = .037), and a trend for infection (aOR, 1.85; P = .067). Comparing patients with shock, group B vs non-B patients had 40% higher fibrinogen, 65% higher factor (F) VIII, 36% higher FIX, 20% higher FXIII, and 19% higher von Willebrand factor. ConclusionIn this observational study limited by single time-point sampling and subgroup analysis of trauma hemorrhage with shock, group B patients have enhanced hemostatic capability associated with early survival but with increased risk of immune-mediated complications.

A46SPEED: an emergency department simulation training model which does not affect patient waiting times

There is a well-recognized tension between clinical service provision and participation in learning events for junior doctors (JDs) in the UK [1]. JDs frequently report that they are unable to attend regular teaching due to departmental clinical pressures, representing lost opportunities for their training and development. Therefore, there is need for development of training methods which minimize impact on clinical service delivery. To develop a simulation training model for Emergency Department (ED) JDs which would a) deliver tailored learning objectives according to the participants’ level of training and b) have minimal impact upon ED service provision. The ‘Simulation and Personalised Education in the Emergency Department’ (SPEED) model was developed. On SPEED days, JDs and advanced clinical practitioners (ACPs) who were undertaking clinical duties in ED on that day were invited on an individual basis to participate in a twenty-minute clinical simulation. Upon completion, the participant underwent a ten-minute debrief to reinforce predetermined learning objectives and supply feedback to simulation tutors before returning to their clinical duties in ED. Pre- and post-session questionnaires were conducted to assess acquisition of learning objectives. Training days were conducted in EDs of a UK Major Trauma Centre (MTC) and an associated small teaching hospital (TH). Departmental data on time to be seen by an ED clinician were collected retrospectively for SPEED days and comparable non-SPEED days, with differentiation between the majors and urgent care (UC) MTC sub-departments. A total of 7 SPEED days were conducted over 6 months between September 2022 and March 2023 – 5 in the MTC ED and 2 in the TH ED. 65 JDs and ACPs participated across the seven days. On asking about the usefulness of the SPEED session for day-to-day practice, 41 participants responded ‘strongly agree’ and 18 participants responded ‘agree’. 6 of the 7 SPEED days demonstrated a positive mean difference in post-session questionnaire score when compared to pre-test questionnaire. There was no statistically significant difference in time to see clinician between SPEED days and comparable non-SPEED days in MTC majors (1h11m vs. 48m), MTC UC (2h41m vs. 2h25m), or TH (1h15m vs. 1h8m) (Kruskal-Wallis test, The SPEED model demonstrates acquisition of learning objectives which are relevant to day-to-day practice. There is no evidence that delivery of this model significantly affects waiting times in either a small or large ED. Adoption of this training strategy may improve training opportunities for other ED clinicians. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

858 The Effect of a ‘Rib Fracture Pathway’ on the Efficiency of Rib Block Delivery at a UK Major Trauma Centre

Abstract Aim Rib fractures carry a mortality rate of 10% which is doubled in the elderly population. They are common following blunt thoracic trauma and are a marker of injury severity. Timely delivery of regional analgesia is crucial to prevent secondary respiratory complications. We compare the time taken from admission to administration of a regional block in patients with &amp;gt;2 rib fractures before and after the implementation of a rib fracture pathway. Method Retrospective data was collected from 22 pre-pathway and 47 post-pathway patients who were given a regional block after suffering &amp;gt;2 rib fractures. Demographic data, ISS, length of stay and respiratory complications were collected. Need for block was determined by clinical factors including uncontrolled pain and limited respiratory effort. Results Time to block from admission was longer in pre-pathway patients (41.9±33.8 vs 23.9±21.2 hours, p = 0.03). There was no significant difference in length of stay (21.6±14.2 vs 19.9±14.5, p = 0.3). Pre-pathway patients were significantly younger (54.6±15.0 vs 66.8±17.4 years, p = 0.006) and had fewer rib fractures (5.4±2.3 vs 7.4±3.5, p = 0.02). The mean ISS was 24.1±10.3 and 18.1±8.5 in the pre- and post-pathway patients, respectfully (p = 0.02). There was no significant difference in post-admission chest infection rates (18.2% vs 23.4%, p = 0.4). Conclusions The time taken from admission to block in patients with multiple rib fractures significantly reduced following the implementation of a ‘Rib Fracture Pathway’ at a UK Major Trauma Centre. Further work is required to determine whether this will affect length of stay or patient outcomes.

1118 Epidemiology of Tibial Fractures, a UK Major Trauma Centre Perspective

Abstract Aim There is no recent large UK-based study on the epidemiology of tibial fractures. In our study, we report incidence and factors associated with tibial fractures treated at a Level I Trauma Centre over a 7-year period. Method We gathered data on fracture locations, age, gender, BMI, Charlson Comorbidity Index (CCI), and treatment options of all tibial fractures treated at a major trauma centre during the seven years from January 2015 to January 2022. The incidence of fracture types was calculated, as well as associations different fracture locations had with demographics, and their surgical managements. Results 2018 patients suffered 2103 tibial fractures during the 7 years. This is composed of 735 proximal (plateau), 775 diaphyseal, and 593 distal (Pilon and tibial ankle component) fractures occurring, with overall incidence per 100,000 patients per year being 18.4, 19.1 and 14.6, respectively. Of all fractures, the mean age, CCI score, and BMI was 46.9 years, 1.54, and 26.6, respectively. 56% were male, 26.3% were open fractures, and 52.4% were treated operatively. Proximal and distal fracture patients had higher (50.9) and lower (43.2) ages, respectively (p&amp;lt;0.01). Proximal and shaft fractures had lower (48.9%) and higher (61.4%) percentages of male patients. Distal (64.4%) and open (79.0%) fractures had higher rates of operative treatment, respectively. Conclusions This study describes the epidemiology and incidence of tibial fractures in the UK major trauma centre setting, and analyses the association between demographic factors, fracture location and management. This adds to the literature and allows for future comparisons between regions.

1070 Epidemiology and Incidence of Pelvic Fractures

Abstract Aim There is a lack of recent UK based literature reporting on the incidence of pelvic fractures, and the demographic associations with fracture locations. Our study reports the incidence and factors associated with pelvic fractures at a major trauma centre over a 7-year period. Method Data from pelvic fractures treated at a Level 1 Trauma Centre was collected from January 2015 to January 2022. Fracture location, patient demographics, and operative status were collected and analysed. Results A total of 3137 patients with pelvic fractures were included, with an incidence of 78.6/100,000 patients per year. The mean age was 63.0, 53% of patients were female and the mean BMI was 25.3. The mean length of hospital admission was 20.5 days. Patients with Pubis fractures had the highest mean age (65.55), whilst those with ilium fractures had the lowest (51.14), both significantly different from the mean (p&amp;lt;0.001). Female patients were more likely to have pubis (60.1%) fractures but less likely to have acetabulum (30.0%) fractures (p&amp;lt;0.01). Patients with acetabular fractures had a higher BMI (p&amp;lt;0.01) and the highest rate of operative fixation (48.5%). Conclusions Our study provides insight into the incidence and epidemiology of pelvic fractures in a UK major trauma centre setting, the first study in over 15 years in this context. This contributes to the literature, and allows inter-country comparisons to be conducted, and guidelines and policies to be more informed.

1200 Polytrauma Clinic in a Major Trauma Centre in the UK – a Novel Approach for Polytrauma Patients

Abstract Introduction The UK major trauma network was successfully implemented in 2012. However, rehabilitation has mainly been described in military veterans. In our unit a multidisciplinary polytrauma clinic attended by an Advanced Physiotherapist, Rehabilitation Medicine Consultant and a Trauma and Orthopaedic Consultant was established to manage these patients after discharge. Method This observational study assessed the polytrauma rehabilitation clinic at a single UK Major Trauma Centre. Eligible patients had 2 or more significant limb injuries +/- pelvic fracture. A retrospective review between 1st July 2016 to 31st July 2021 was performed. Electronic records were assessed for mechanism of injury, number of injuries requiring surgery, length of inpatient stay, number of clinic appointments, diagnosis of post-traumatic amnesia and re-admission. Results Of a total of 87 patients, 68% sustained injuries following road traffic collisions. Mean number of injuries per patient was 5.9 SD+/- 2.6, mean operations performed per patient 4.3 SD+/- 4. Patients had a mean of 1.4 SD+/- 0.6 reviews per year in the clinic, with 1.5 +/- 0.6 years of follow-up. 14% of patients had post-traumatic amnesia. Re-admission was required for 24 patients, of which 21 (87.5%) were planned. Conclusions The polytrauma clinic introduced a multi-disciplinary approach to the aftercare of this patient population, whilst reducing their appointment burden. This study found patients required 1-2 appointments per year, demonstrating a cost-effective approach to follow up. The streamlining of required interventions in a timely manner is supported by the fact that over 70% of patients did not require further admissions for treatment.

Microbiological Profile of Fracture Related Infection at a UK Major Trauma Centre.

Fracture Related Infection (FRI) represents one of the biggest challenges for Trauma and Orthopaedic surgery. A better understanding of the microbiological profile should assist with decision-making and optimising outcomes. Our primary aim was to report on the microbiological profile of FRI cases treated over a six-year period at one of Europe's busiest trauma centres. Secondarily, we sought to correlate our findings with existing anti-microbiological protocols and report on diagnostic techniques employed in our practice. All adult cases of FRI treated in our institution between 2016 and 2021 were identified, retrospectively. We recorded patient demographics, diagnostic strategies, causative organisms and antibiotic susceptibilities. There were 330 infection episodes in 294 patients. A total of 463 potentially pathogenic organisms (78 different species) were identified from cultures, of which 57.2% were gram-positive and 39.7% gram-negative. Polymicrobial cultures were found in 33.6% of cases and no causative organism was found in 17.5%. The most prevalent organisms were Staphylococcus aureus (24.4%), coagulase-negative Staphylococci (14%), Pseudomonas aeruginosa (8.2%), Enterobacter species (7.8%) and Escherichia coli (6.9%). Resistant gram-positive organisms (methicillin resistant Staphylococcus aureus or vancomycin-resistant Enterococci) were implicated in 3.3% of infection episodes and resistant gram-negatives (extended-spectrum beta-lactamase, ampC or carbapenemase-producing bacteria) in 13.6%. The organisms cultured in 96.3% of infection episodes would have been covered by our empirical systemic antibiotic choice of teicoplanin and meropenem. To our knowledge, this is the largest reported single-centre cohort of FRIs from a major trauma centre. Our results demonstrate patterns in microbiological profiles that should serve to inform the decision-making process regarding antibiotic choices for both prophylaxis and treatment.

FTP1.5 The forgotten tribe in healthcare? Mechanism of injury and outcome of injured adolescents in a UK Major Trauma Centre

Abstract Aim Trauma is the leading cause of mortality in the adolescent and young adult population. Adolescents, particularly those aged 16-17 years often fall between provisions of traditional adult and paediatric services. This study examines the outcomes for injured adolescents treated at one combined adult/paediatric UK major trauma centre. Methods An observational study included patients aged 10-24.99 years treated at a single MTC between April 2020 and April 2022. Demographic and injury mechanism and severity (ISS) data were recorded for three subgroups: paediatric (10-15 years), transitional (16-17) and young adult (18-24). Outcomes were compared including length of stay, surgical procedures and mortality. Results 343 patients were included (78.4% male). 16-17 year olds were significantly more likely to be victims of violence and require a longer stay in hospital. Mortality was 4.1% overall. Conclusions It is vital that the specific needs of young people aged 16-17 are recognised in terms of violence reduction and injury prevention strategies, and in planning and delivery of hospital services.

Concussion in facial trauma patients: a retrospective analysis of 100 patients from a UK major trauma centre

Concussion is a common and potentially debilitating condition. Research has shown that one-third of patients admitted with facial trauma have concurrent concussion. This study aimed to investigate the burden and management of concussion in patients presenting with acute facial trauma, and to identify potential risk factors within this population. A retrospective observational study was conducted at a UK major trauma centre between 1 January 2019 and 1 February2020. One hundred randomly selected patients who attended the acute clinic responsible for managing facial trauma were identified. No parametric data were included. The Mann-Whitney test was used to detect differences for continuous data, the X2 test for categorical data. Clinical significance was defined as p < 0.05. Forty of 100 patients (40%) had evidence of concussion, of which only 4/40 (10%) had evidence that head injury advice had been given. There was no statistically significant difference between the non-concussed and concussed groups for age (p = 0.145), gender (p = 0.921), mechanism of injury (p = 0.158), or location of facial injury (p = 0.451). Clinical features of concussion were found in 40% of patients suffering from facial injury. Despite this, we found that head injury advice was rarely given. In addition, we identified no risk factors for concussion within this population, highlighting the need to screen all patients who present with facial injury. To improve the identification and management of concussion in these patients, future work should focus on the development of simple screening tools for use in clinic, and the signposting of patients to existing written and online concussion resources.

Predictors of long-term survival in 5,680 patients admitted to a UK major trauma centre with thoracic injuries.

The long-term outcomes of chest trauma are largely unknown. We sought to determine the predictors of in-hospital and long-term survival in patients admitted to a major trauma centre (MTC) with chest injuries and to evaluate spatial patterns of injury in our network area. Retrospective analysis of data collected on the National Trauma Audit Research Network (TARN) database using multivariate analysis and Cox regression analysis. Spatial analysis was performed using ArcGis 10.7.1. Some 5,680 patients were admitted with chest trauma between December 1999 and December 2019. Median patient age was 45 years and the median Injury Severity Score (ISS) was 20. The proportion of patients who had an operation was 39.8%. Age, blood transfusion, head injury, shock, emergency thoracotomy and heart disease were predictors of hospital mortality (p < 0.05). However, having an operation on concomitant injuries was protective. ISS and Glasgow Coma Score were discriminators of in-hospital mortality (C-indices 0.76 and 0.80, respectively). The 10-year survival values for patients who survived to discharge from hospital and who were aged <40, 50, 60, 70, 80 and >80 years were 99%, 93%, 95%, 87%, 75% and 43%, respectively. Preadmission lung disease and alcohol/drug misuse were poor predictors of long-term survival (p < 0.05). Hotspot analysis revealed the areas with the highest incidents were all close to the MTC. The MTC is geographically central to areas with high numbers of trauma incidents. Although emergency thoracotomy was a predictor of poor in-hospital outcomes, having surgery for concomitant injuries improved outcomes. Patients surviving to discharge have good long-term survivals.

Examining the validity of the Delis-Kaplan Executive Function System (D-KEFS) in traumatic brain injury.

This study examines the validity of the Delis-Kaplan Executive Function System (D-KEFS) in a traumatic brain injury (TBI) population compared to participants with orthopaedic injuries and normative controls. The utility of the D-KEFS was examined using a between groups design. One hundred patients with mild uncomplicated to severe TBI were recruited from a consecutive cohort of patients admitted as inpatients to a UK Major Trauma Centre and compared to 823 participants from the D-KEFS normative sample and 26 participants with orthopaedic injuries. Data were filtered for performance validity. Sample discrimination was calculated from D-KEFS subtest scores and derived index scores. Sensitivity to TBI severity was established. The TBI participants performed significantly lower on the D-KEFS Trail Making Test, Colour Word Interference, Colour Word Switching, Letter Fluency and Verbal Fluency Category Switching Total Words Correct. The D-KEFS index scores discriminated between TBI, orthopaedic and normative participants with large and moderate effect sizes, respectively. The D-KEFS demonstrated a dose-response relationship with TBI severity. These effects were robust to differences in premorbid intellectual functioning; however, D-KEFS performance was sensitive to performance on tests of mental processing speed. The use of a D-KEFS index score provides a robust and reliable discrimination of TBI patients from healthy control participants. This discrimination is not accounted for by premorbid intellect or the non-specific effects of trauma. The clinical and conceptual implications of these findings are considered.