A study carried out by doctors at University Hospital Galway (UHG) has revealed a doubling of trauma cases amidst older patients over the course of a decade. Based on critical care data from UHG, the study looked at the characteristics of trauma patients, nature of their injuries and trends in mortality rates over the ten-year period.
A review of 709 patients admitted with major trauma (a serious injury with the potential of causing death and disability) was undertaken between 2010 and 2021 as part of the study.
“Trauma remains one of the commonest causes of death and disability worldwide. Over the last decade, we have seen a significant change in the pattern and demographic of major trauma presenting to our centre, and in those requiring critical care input,” according to the lead author of the study, Dr Ciara Hanley, UHG Consultant Anaesthesiologist.
In the ten-year period, trauma cases doubled while patients aged 65 and older accounted for 45.7% of all admissions. Within this older cohort, 47.5% of patients were aged 80 and over. The study found that most of these older patients had good outcomes overall, with most of them undergoing surgical intervention and were discharged from critical care within 48 hours.
Key Study Highlights
- 97.6% of cases had blunt force trauma injuries caused by either a fall (45.4%) or road traffic accident (29.2%).
- Orthopaedic, thoracic and spinal trauma were the most frequent organ systems injured (53%, 37% and 32.5% respectively).
- Admissions are predominately male, with an overall mean of 68.4%.
- Frailty has a significant adverse impact in older patients including increased 30-day mortality, increased incidence of complications, delayed discharge, and increased readmission rates.
“Trauma remains one of the commonest causes of death and disability worldwide” – Dr Ciara Hanley
The study highlights the specialist care delivered by the critical care team in UHG, a designated Trauma Unit with Specialist Services (TUSS). Out of the 400 patients who underwent surgical treatment at the regional site in Galway, only 51 patients required an inter-hospital transfer for specialist management not provided in UHG.
Speaking about the national trauma system Dr Hanley said: “University Hospital Galway plays a pivotal and unique role within the trauma network in Ireland. The Major Trauma Audit National Report in 2018 led to the transformation of structures and processes in relation to trauma management in Ireland, deliver a national high-quality graded hub-and-spoke network of trauma services in line with international best practice.
“A key factor in the success of the trauma network will be appropriate and timely funding and resourcing of the UHG to enable it to continue to provide high quality trauma care in line with international best practice. This will facilitates equity of access to trauma care services, while also maintaining the high-volume practice, and clinical expertise within the region.”
Chris Kane, GUH Hospital Manager said; “The study contains many useful learnings for us as we strive to deliver excellence in trauma care considering a changing demographic and an increasing incidence of older patients who can have multiple and complex care needs.” He also acknowledged the “incredible work being carried out by our critical care team who are seeing a sustained increase in demand over recent years”.
Prof John Laffey, UHG Consultant in Anaesthesia and Intensive Care Medicine, concluded; “As a Trauma Unit with Specialist Services, our hospital is uniquely positioned to deliver exceptional care, despite the challenges posed by our extensive catchment area and the prolonged transfer time to the Major Trauma Centre. The doubling of critical care trauma admissions over the past decade underscores the increasing demand for our services, particularly among older adults.”
Click here to read the findings on ‘Major trauma patients and their outcomes – A retrospective observational study of critical care trauma admissions to a trauma unit with special services’
