Ageing population has changed the nature of major thoracic injury

2019 ◽  
Vol 36 (6) ◽  
pp. 340-345 ◽  
Author(s):  
Noha Ferrah ◽  
Peter Cameron ◽  
Belinda Gabbe ◽  
Mark Fitzgerald ◽  
Rodney Judson ◽  
...  
Keyword(s):  
System Design ◽  
Major Trauma ◽  
Trauma System ◽  
Age Groups ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
Ageing Population ◽  
Thoracic Injuries ◽  
Pattern Of Injury ◽  
Trauma Population

IntroductionAn increasing proportion of the major trauma population are older persons. The pattern of injury is different in this age group and serious chest injuries represent a significant subgroup, with implications for trauma system design. The aim of this study was to examine trends in thoracic injuries among major trauma patients in an inclusive trauma system.MethodsThis was a retrospective review of all adult cases of major trauma with thoracic injuries of Abbreviated Injury Scale score of 3 or more, using data from the Victorian State Trauma Registry from 2007 to 2016. Prevalence and pattern of thoracic injury was compared between patients with multitrauma and patients with isolated thoracic injury. Poisson regression was used to determine whether population-based incidence had changed over the study period.ResultsThere were 8805 cases of hospitalised major trauma with serious thoracic injuries. Over a 10-year period, the population-adjusted incidence of thoracic injury increased by 8% per year (incidence rate ratio [IRR] 1.08, 95% CI 1.07 to 1.09). This trend was observed across all age groups and mechanisms of injury. The greatest increase in incidence of thoracic injuries, 14% per year, was observed in people aged 85 years and older (IRR 1.14, 95% CI 1.09 to 1.18).ConclusionsAdmissions for thoracic injuries in the major trauma population are increasing. Older patients are contributing to an increase in major thoracic trauma. This is likely to have important implications for trauma system design, as well as morbidity, mortality and use of healthcare resources.

Pediatric Secondary Overtriage in a Statewide Trauma System

2016 ◽  
Vol 82 (9) ◽  
pp. 763-767 ◽  
Author(s):  
Alexander Leung ◽  
Patrick Bonasso ◽  
Kevin Lynch ◽  
Dustin Long ◽  
Richard Vaughan ◽  
...  
Keyword(s):  
Trauma System ◽  
Age Groups ◽  
Young Patients ◽  
Comfort Level ◽  
Trauma Patients ◽  
Factors Associated ◽  
Local Facility ◽  
Patient Arrival ◽  
Clinical Indices ◽  
Patterns Of Injury

Secondary overtriage is a term that describes patients who are discharged home shortly after being transferred, an indication that transfer and hospitalization were unnecessary. The study goal was to identify factors associated with secondary triage. A statewide trauma registry was used to identify trauma patients aged less than 18 years during a 6-year period (2007–2012) who were discharged within 48 hours from arrival and did not undergo a surgical procedure. We compared those that were treated at initial facility and those transferred to a second facility using clinical indices including patterns of injury pattern using multivariate logistic regression. Of the 4441 patients who fit our inclusion criteria, 801 (18%) were transferred. Younger age groups were more likely to be transferred. Factors associated with being transferred included head, spinal, and facial injuries, and patient arrival during the nighttime work shifts. In conclusion, young patients who have signs of possible neurological or spinal injuries and those who arrive during nondaytime shifts during the workday are more likely to be transferred to another trauma center. These may reflect the comfort level and resources of the local facility.

Transporting major trauma patients from the margins of a UK trauma system

2011 ◽  
Vol 29 (3) ◽  
pp. 182-183 ◽  
Author(s):  
Tim Nutbeam ◽  
Alan Leaman ◽  
Peter Oakley
Keyword(s):  
Major Trauma ◽  
Trauma System ◽  
Trauma Patients

scholarly journals Undertriage of Pediatric Major Trauma Patients in the United States

2017 ◽  
Vol 56 (9) ◽  
pp. 845-853 ◽  
Author(s):  
Jin Peng ◽  
Krista Wheeler ◽  
Jonathan I. Groner ◽  
Kathryn J. Haley ◽  
Henry Xiang
Keyword(s):  
Rural Areas ◽  
Chronic Conditions ◽  
Major Trauma ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
The United States ◽  
Trauma Patients ◽  
Trauma Population ◽  
Life Threatening ◽  
Delivery Models

Although trauma undertriage has been widely discussed in the literature, undertriage in the pediatric trauma population remains understudied. Using the 2009-2013 Nationwide Emergency Department Sample, we assessed the national undertriage rate in pediatric major trauma patients (age ≤16 years and injury severity score [ISS] >15), and identified factors associated with pediatric trauma undertriage. Nationally, 21.7% of pediatric major trauma patients were undertriaged. Children living in rural areas were more likely to be undertriaged ( P = .02), as were those without insurance ( P = .00). Children with life-threatening injuries were less likely to be undertriaged ( P < .0001), as were those with chronic conditions ( P < .0001). Improving access to specialized pediatric trauma care through innovative service delivery models may reduce undertriage and improve outcomes for pediatric major trauma patients.

Prehospital triage and survival of major trauma patients in a Dutch regional trauma system: relevance of trauma registry

2006 ◽  
Vol 391 (4) ◽  
pp. 343-349 ◽  
Author(s):  
Leontien M. Sturms ◽  
Josephine M. Hoogeveen ◽  
Saskia Le Cessie ◽  
Peter E. Schenck ◽  
Paul V. M. Pahlplatz ◽  
...  
Keyword(s):  
Major Trauma ◽  
Trauma Registry ◽  
Trauma System ◽  
Trauma Patients ◽  
Prehospital Triage

scholarly journals Study of the characteristics and burden of pediatric trauma in low resource settings.

2020 ◽  
Vol 27 (09) ◽  
pp. 1958-1965
Author(s):  
Shafiq Ur Rehman ◽  
Yasir Makki ◽  
Saad Fazal ◽  
Hafiza Swaiba Afzal ◽  
Fareena Ishtiaq
Keyword(s):  
Pediatric Trauma ◽  
Age Groups ◽  
Penetrating Trauma ◽  
Cross Sectional Study ◽  
Common Type ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Pattern Of Injury ◽  
Significant Burden ◽  
Type Of Injury

Objectives: Purpose of the study is to identify the characteristics and burden of pediatric trauma in a hospital with limited resources and to compare the results with published literature and to formulate the effective injury prevention strategies. Study Design: Prospective, Descriptive, Cross-sectional study. Setting: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2019 to December 2019. Material & Methods:  A total of 871 patients aged 12 years and below with a history of trauma were included. The patients were categorized into four age groups, 0-2 years, 3-5 years, 6-8 years, and 9-12 years. Data collected included, age, gender, area (rural/urban), type of injury, mechanism of injury, regional pattern of injury, any intervention required and final outcome. The data were compared in different age groups and both sexes. Results: Out of total 2609 admissions, 871(33.38%) patients were of trauma and burn. 699(80.3%) trauma patients and 172(19.7%) burn patients. The males were 595(67.9%) and females comprised 276(32.1%). Age ranged from 05 days to 12 years (mean5.07years). By age groups, distribution of patients was, 0-2years 201(23.1%), 3-5years 340(39.0%), 6-8years 213(24.5%), and 9-12years 117(13.4%). Blunt trauma was most common type of injury 688(95.56%) and penetrating trauma was 31(4.43%). Most common mechanisms of injury were, vehicle related incidents 380(54.4%) and fall 238(34.0%). The majority of injuries 432(61.8%), were seen in head, neck and face region. Scald was most common type of burn and seen in 125(14.4%) patients. Conclusion:  This study clearly shows that pediatric injuries and burn contribute a substantial proportion of all pediatric surgical admissions. Pediatric trauma including burn is a significant burden on health care system. Vehicle related incidents, fall injuries and scald burns are most common type of injuries.

scholarly journals Age and the distribution of major injury across a national trauma system

2019 ◽  
Vol 49 (2) ◽  
pp. 218-226
Author(s):  
Jan Robert Dixon ◽  
Fiona Lecky ◽  
Omar Bouamra ◽  
Paul Dixon ◽  
Faye Wilson ◽  
...  
Keyword(s):  
Older Patients ◽  
Major Trauma ◽  
National Level ◽  
Trauma System ◽  
Injured Patient ◽  
Healthcare Services ◽  
Research Network ◽  
Trauma Patients ◽  
Significant Burden ◽  
Trauma Networks

Abstract Background Trauma places a significant burden on healthcare services, and its management impacts greatly on the injured patient. The demographic of major trauma is changing as the population ages, increasingly unveiling gaps in processes of managing older patients. Key to improving patient care is the ability to characterise current patient distribution. Objectives There is no contemporary evidence available to characterise how age impacts on trauma patient distribution at a national level. Through an analysis of the Trauma Audit Research Network (TARN) database, we describe the nature of Major Trauma in England since the configuration of regional trauma networks, with focus on injury distribution, ultimate treating institution and any transfer in-between. Methods The TARN database was analysed for all patients presenting from April 2012 to the end of October 2017 in NHS England. Results About 307,307 patients were included, of which 63.8% presented directly to a non-specialist hospital (trauma unit (TU)). Fall from standing height in older patients, presenting and largely remaining in TUs, dominates the English trauma caseload. Contrary to perception, major trauma patients currently are being cared for in both specialist (major trauma centres (MTCs)) and non-specialist (TU) hospitals. Paediatric trauma accounts for &lt;5% of trauma cases and is focussed on paediatric MTCs. Conclusions Within adult major trauma patients in England, mechanism of injury is dominated by low level falls, particularly in older people. These patients are predominately cared for in TUs. This work illustrates the reality of current care pathways for major trauma patients in England in the recently configured regional trauma networks.

Older people and major trauma

2009 ◽  
Vol 19 (2) ◽  
pp. 77-85 ◽  
Author(s):  
Elaine Cole ◽  
Antonia Lynch ◽  
Jackie Bridges ◽  
Anita West
Keyword(s):  
Older People ◽  
Major Trauma ◽  
Traumatic Injury ◽  
Psychological Impact ◽  
Age Groups ◽  
Adverse Outcomes ◽  
Practice Research ◽  
Trauma Patients ◽  
Policy Practice ◽  
Research And Education

SummaryMajor traumatic injury is a leading cause of death in younger age groups, but increasingly older people are affected also. Adverse outcomes, both physical and psychological, are associated with injury in the older population. This review aims to locate and describe the evidence relating to older people and major trauma in order to inform policy, practice, research and education. The published research and systematic reviews fall into three main topics: mechanism of traumatic injury in older people, the effects of co-morbidities on older trauma patients and outcomes following serious traumatic injury in older people. The psychological impact of traumatic injury and the resulting functional alteration cannot be underestimated in this group of patients.

scholarly journals 251 The frailty in major trauma study (FRAIL-T): feasibility of nurse lead frailty assessment in elderly trauma and the impact on outcomes

2020 ◽  
Vol 37 (12) ◽  
pp. 840.2-840
Author(s):  
Heather Jarman ◽  
Robert Crouch ◽  
Mark Baxter ◽  
Bebhinn Dillane ◽  
Chao Wang ◽  
...  
Keyword(s):  
Best Practice ◽  
Major Trauma ◽  
Frailty Index ◽  
Kappa Statistic ◽  
Trauma Team ◽  
Trauma Patients ◽  
Clinical Frailty Scale ◽  
Frailty Assessment ◽  
Trauma Population ◽  
The Impact

Aims/Objectives/BackgroundFrailty screening for major trauma patients has recently become part of the best practice commissioning tariff within NHS England, yet there is no consensus as to who should carry out this assessment or which tool best identifies frailty in the Emergency Department (ED). As the trauma population ages there is a need for accurate early identification of frailty in the ED to underpin frailty specific major trauma pathways. The primary aim of this study was to determine the feasibility and accuracy of ED nurse-led frailty assessment in patients ≥ 65 years admitted to Major Trauma Centres (MTCs).Methods/DesignA prospective observational study was conducted across five UK MTCs, enrolling 370 participants over nine months. Eligible patients were aged 65 or more requiring trauma team activation. Frailty was assessed in the ED using three different tools: Trauma Specific Frailty Index (TSFI); Clinical Frailty Scale (CFS); PRISMA-7. ED nurse frailty assessment was correlated with Geriatrician assessment within 72 hours of admission using Spearman’s correlation coefficient and kappa statistic for measuring the interrater agreement.Results/ConclusionsComplete frailty assessments were calculated for CFS in 99.4% of patients, PRISMA7 in 95.9% and TSFI in 37.58%. Rates of frailty differed between tools: CFS 32%, PRISMA7 57% and TSFI 92% whilst Geriatrician determined frailty was 37%. In all tools frail patients were older (p<0.001) and falls <2 m were the leading mechanism of injury (p<0.05). CFS showed both strong correlation (rs 0.639,p<0.001) and substantial agreement (kappa 0.637,p<0.001) with Geriatrician assessment within 72 hours of admission.ED nurses can accurately assess older major trauma patients for frailty using the Clinical Frailty Scale. These findings support assessment of frailty in the ED in order to identify patients who would benefit from early frailty specific care.

scholarly journals Helicopter emergency medical service dispatch in older trauma: time to reconsider the trigger?

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
J. E. Griggs ◽  
◽  
J. W. Barrett ◽  
E. ter Avest ◽  
R. de Coverly ◽  
...  
Keyword(s):  
Critical Care ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma System ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Emergency Medical ◽  
Major Trauma Centre ◽  
Head Injured ◽  
Injured Patients

Abstract Background Helicopter Emergency Medical Services (HEMS) respond to serious trauma and medical emergencies. Geographical disparity and the regionalisation of trauma systems can complicate accurate HEMS dispatch. We sought to evaluate HEMS dispatch sensitivity in older trauma patients by analysing critical care interventions and conveyance in a well-established trauma system. Methods All trauma patients aged ≥65 years that were attended by the Air Ambulance Kent Surrey Sussex over a 6-year period from 1 July 2013 to 30 June 2019 were included. Patient characteristics, critical care interventions and hospital disposition were stratified by dispatch type (immediate, interrogate and crew request). Results 1321 trauma patients aged ≥65 were included. Median age was 75 years [IQR 69–89]. HEMS dispatch was by immediate (32.0%), interrogation (43.5%) and at the request of ambulance clinicians (24.5%). Older age was associated with a longer dispatch interval and was significantly longer in the crew request category (37 min [34–39]) compared to immediate dispatch (6 min [5–6] (p = .001). Dispatch by crew request was common in patients with falls < 2 m, whereas pedestrian road traffic collisions and falls > 2 m more often resulted in immediate dispatch (p = .001). Immediate dispatch to isolated head injured patients often resulted in pre-hospital emergency anaesthesia (PHEA) (39%). However, over a third of head injured patients attended after dispatch by crew request received PHEA (36%) and a large proportion were triaged to major trauma centres (69%). Conclusions Many patients who do not fulfil the criteria for immediate HEMS dispatch need advanced clinical interventions and subsequent tertiary level care at a major trauma centre. Further studies should evaluate if HEMS activation criteria, nuanced by age-dependant triggers for mechanism and physiological parameters, optimise dispatch sensitivity and HEMS utilisation.

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