Mark BaxterDoctors in Southampton have helped to produce the first national review of major trauma in older people – two years after highlighting the need for “urgent action” to improve care in the age group.
The Trauma Audit and Research Network (TARN) report, co-authored by Dr Mark Baxter, director of major trauma at University Hospital Southampton NHS Foundation Trust, looked at 8,176 injured patients aged 60 and above over 10 years.
The analysis found the typical severely injured patient is no longer the traditional young male in a road traffic accident but an older person who has suffered a fall.
It also showed older people with major injuries are less likely than younger adults to be taken directly to a major trauma centre – such as Southampton General Hospital – for specialist care due to the challenges of reliably identifying major injury in older patients at the scene.
“The report makes it clear that there is a change in the nature of patients who suffer from major trauma and we need to adapt to this new reality,” explained Dr Baxter, who is a consultant orthogeriatrician at UHS.
“Older people, often with frailty, present a specific challenge to the trauma centres as they are more likely to have other co-existing illnesses which require a different response with specialists in care of older people involved in their care from the outset.”
In 2015, Dr Andy Eynon, a former director of major trauma at UHS and a consultant in neurosciences intensive care, said the development of major trauma networks across the county in 2012 had been “a revelation” and had saved hundreds more lives a year, but the elderly population had been “forgotten amid the successes”.
“With admissions among this group increasing rapidly and a growing elderly population in the country, it is a problem that needs to be addressed urgently," he said.
The Southampton team, led by anaesthetist Dr Laura Tompsett, evaluated trauma care among older people in the south central region and found 67 of 282 patients reviewed from April 2012 to August 2014 suffered a missed injury or delayed diagnosis – despite 43% presenting with predictable signs of major trauma.
As a result, they pioneered a trauma and orthopaedic medical service for the over 65s, led by Dr Baxter and his colleagues, to tackle the issue by ensuring immediate input from elderly care specialists to identify injuries earlier, quicker access to treatment and a fast, more coordinated recovery and rehabilitation.
He added: “We have made a good start at UHS in improving care for older people with major trauma but there is much more work to do locally, regionally and nationally to bring it up to standard and ensure it is maintained.
“This report is another important step forward in focusing attention on major trauma care for older people.”
In addition to monitoring the standards of care across major trauma units and centres, TARN has started to collect patient reported outcome measures (PROMs) across trauma centres in England.
Antoinette Edwards, executive director of TARN, said: “From the data gathered so far, it would seem that older patients are more likely to tell us how they are feeling after their injury.
“PROMs is a great opportunity for us measure long-term outcomes and help us to improve our understanding on how major injury has impacted not just on patients’ health but also their everyday routines.”
Posted on Thursday 6 April 2017