Demographics, management and outcomes of major trauma in older patients at an Irish trauma unit.

Abstract

Background: Major trauma data in the developed world trends towards increased rates of lower energy mechanism in an older cohort. This study examines how the mechanism of trauma, injury pattern and outcomes differ between a younger and older cohorts in an Irish trauma unit.

Methods: In this retrospective study, all entries to the Trauma Audit and Research Network (TARN) database from Tallaght University Hospital, between January 1st 2016 and 31st December 2021, were interrogated. Differences between injury severity, 30-day mortality, and hospital length of stay in younger and older patients were also examined.

Results: Older patients (≥ 65 years) had a similar severity of injury to younger patients (< 65 years); however, they had longer stays in hospital (18.8 versus 9.5 days, p < 0.001). Older patients (≥ 65 years) were more likely to have head (16.1% versus 11.3%, p < 0.05) and cervical spine (21.4% versus 11.2%, p < 0.05) injuries as their primary injury compared with younger patients. Older patients (≥ 65 years) are less likely to have limb (33.3% versus 45.6%, p < 0.05). Fall from a height less than 2 m was more likely to be the mechanism of injury in the older cohort compared with the younger cohort (77.3% versus 36.3%, p < 0.05).

Conclusion: This study highlights the increased mortality and morbidity experienced by older trauma patients compared with a younger cohort. The findings support the development of "silver trauma" care pathways and directing resources to meet the needs of older trauma patients and optimize clinical outcomes.