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

3. 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)

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

5. 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

6. 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

7. 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

8. 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

9. 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