More evidence needed to prove major trauma centres are best for older persons major trauma
Date First Published:
June 24, 2022
Last Updated:
July 25, 2024
Report by:
Melinda (Dolly) Mcpherson, Advanced Clinical Practitioner (University hospital Southampton)
Three-Part Question:
In [frail older patients with major trauma] Is [management at a major trauma centre better than management at a trauma unit] At [optimising patient outcomes and experience].
Clinical Scenario:
An ambulance crew calls the local trauma unit with an 85 year old female they suspect of being major trauma. They want to know if she should be brought to the trauma unit or taken to the major trauma centre?
Search Strategy:
Search strategy:
MEDLINE 1966-05/22, CINAHL 1982-05/22 Via EBSCOhost and AMED 1985-05/22, EMBASE 1974-05/22 via Ovid. In addition, the Cochrane database was searched.
Search re-run July 2024 649 papers with 5 of relevance
MEDLINE 1966-05/22, CINAHL 1982-05/22 Via EBSCOhost and AMED 1985-05/22, EMBASE 1974-05/22 via Ovid. In addition, the Cochrane database was searched.
Search re-run July 2024 649 papers with 5 of relevance
Search Details:
EBSCOhost
TX ( Frail OR Old OR “older person” OR Geriatric OR Frailty OR silver ) AND TX ( “major trauma” OR “silver trauma” OR Trauma OR polytrauma ) AND TX ( “Major Trauma Centre” OR “Trauma unit” OR “Level 1 centre” OR “Level 2 centre” OR MTC ) AND TX ( Outcome OR Experience OR “Patient centred” OR Mortality OR Morbidity OR survival )
OVID
((Frail or Old or 'older person' or Geriatric or Frailty or silver) and ('major trauma' or 'silver trauma' or Trauma or polytrauma) and ('Major Trauma Centre' or 'Trauma unit' or 'Level 1 centre' or 'Level 2 centre' or MTC) and (Outcome or Experience or 'Patient centred' or Mortality or Morbidity or survival)).af
TX ( Frail OR Old OR “older person” OR Geriatric OR Frailty OR silver ) AND TX ( “major trauma” OR “silver trauma” OR Trauma OR polytrauma ) AND TX ( “Major Trauma Centre” OR “Trauma unit” OR “Level 1 centre” OR “Level 2 centre” OR MTC ) AND TX ( Outcome OR Experience OR “Patient centred” OR Mortality OR Morbidity OR survival )
OVID
((Frail or Old or 'older person' or Geriatric or Frailty or silver) and ('major trauma' or 'silver trauma' or Trauma or polytrauma) and ('Major Trauma Centre' or 'Trauma unit' or 'Level 1 centre' or 'Level 2 centre' or MTC) and (Outcome or Experience or 'Patient centred' or Mortality or Morbidity or survival)).af
Outcome:
649 papers with 5 of relevance
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth Elizabeth Brown, Hideo Tohira, Paul Bailey, Daniel Fatovich, Gavin Pereira, Judith Finn 03/03/2019 Australia | Adult major trauma patients with an Injury Severity Score (ISS) >15 who were transported to hospital between 1 January 2013 and 31 December 2016. | Retrospective cohort study | Australian trauma network differs to that of the UK Possible unknown confounders affecting multivariate analysis In-hospital mortality secondary outcome only Data unable to capture original decision making regarding reasons for transport to non-trauma centre. |
||
| 734 ACUTE CARE PATHWAYS FOR OLDER MAJOR TRAUMA PATIENTS: A SURVEY OF UK PRACTICE H Jarman, E Cole, R Crouch, M Halter, G Peck | 20/27 Major Trauma Centres (MTCs), 33 Trauma Units (TU's) and two local emergency hospitals For patients aged 55-82 years |
Cross sectional online survey | Presentation abstract only published Online survey Self-reported systems by individual hospitals – risk of bias |
||
| Care of the older trauma patient following low-energy transfer trauma —highlighting a research void Michael Tonkins, Daniel Bradbury, Paul Bramley, Lisa Sabir, Anna Wilkinson, Fiona Lecky | Adults admitted to hospital due to low energy trauma. | Systematic review | All studies were at risk of bias All studies US based Overlapping populations across studies |
Author Commentary:
The comprehensive systematic review by Tonkins et all specifically addresses the 3-part question and notes that further research is required. This best bets review found no additional evidence strong enough to change or shape current UK practice.
Bottom Line:
This topic would warrant further research
References:
- Elizabeth Brown, Hideo Tohira, Paul Bailey, Daniel Fatovich, Gavin Pereira, Judith Finn. Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth
- H Jarman, E Cole, R Crouch, M Halter, G Peck. 734 ACUTE CARE PATHWAYS FOR OLDER MAJOR TRAUMA PATIENTS: A SURVEY OF UK PRACTICE
- Michael Tonkins, Daniel Bradbury, Paul Bramley, Lisa Sabir, Anna Wilkinson, Fiona Lecky. Care of the older trauma patient following low-energy transfer trauma —highlighting a research void
- Van Ditshuizen, J.C., Van Den Driessche, C.R.L., Sewalt, C.A., Van Lieshout, E.M.M., Verhofstad, M.H.J. and Den Hartog, D., . The association between level of trauma care and clinical outcome measures: A systematic review and meta-analysis.
- Tonkins, M., Bouamra, O. and Lecky, F.. Association between major trauma centre care and outcomes of adult patients injured by low falls in England and Wales.