Midland Critical Care & Trauma Network – 25 May 2016 Elderly Trauma Professor Sir Keith Porter Professor of Clinical Traumatology Queen Elizabeth Hospital Birmingham

Case BB (May 2016) 91 year old lady Fall downstairs, long lie BP 181/94 P 102 RR 17 O2 94 on air GCS 15 Ambulance Service diagnosis Fractured clavicle Bruising around eye ? UTI (recent confusion)

Case BB (May 2016) Traumagram Left clavicle fracture Left 1-4 rib fractures (flail 2-3) Right 1st rib fracture T1, T4, T5 wedgefractures

Case BB (May 2016) No trauma alert Routine ED management CXR Inadequate pain relief (paracetamol) +ve urine dip – admitted under Physicians Incomplete initial CT Transferred to Major Trauma Service and HDU bed 24hrs

The Changing Face of Major Trauma in the UK Kehoe A et al 2015 – landmark study Trauma Audit Research Network (TARN) database Review 1990-end 2013 n=116,467 Fields of interest: Age Gender Mechanism of injury Percentage use of CT Kehoe A et al Emerg Med J 2015;32:613-15

Mechanism of Injury RTC Falls greater than 2 metres Falls less than 2 metres Shootings and stabbings Others Kehoe A et al Emerg Med J 2015;32:613-15

Results – ISS>15 Mean age Group Size (age) Males CT Scans 1990 = 36.1 years 2013 = 53.8 years Group Size (age) 1990 = under 25 years (39.3%) 1990 = over 75 years (8.1%) 2013 = under 25 years (17%) 2016 = over 75 years (26.9%) Males 1990 = 72.7% 2013 = 65.3% CT Scans 1990 = 33.6% 2013 = 86.8% Kehoe A et al Emerg Med J 2015;32:613-15

Mechanism of Injury 1990 RTC (59.1%) Falls greater than 2 metres (18.6%) Falls less than 2 metres (4.7%) Shootings and stabbings (0.2%) Others (17.4%) 2013 RTC (29.5%) Falls greater than 2 metres (18%) Falls less than 2 metres (39.1%) Shootings and stabbings (1.9%) Other (11.5%) Kehoe A et al Emerg Med J 2015;32:613-15