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Three Part Question

In [frail older patients with major trauma] Is [management at a major trauma centre better than management at a trauma unit] At [optimising patient outcomes and experience].

Clinical Scenario

An ambulance crew calls the local trauma unit with an 85 year old female they suspect of being major trauma. They want to know if she should be brought to the trauma unit or taken to the major trauma centre?

Search Strategy

Search strategy:
MEDLINE 1966-05/22, CINAHL 1982-05/22 Via EBSCOhost and AMED 1985-05/22, EMBASE 1974-05/22 via Ovid. In addition, the Cochrane database was searched.

Search re-run July 2024 649 papers with 5 of relevance
EBSCOhost
TX ( Frail OR Old OR “older person” OR Geriatric OR Frailty OR silver ) AND TX ( “major trauma” OR “silver trauma” OR Trauma OR polytrauma ) AND TX ( “Major Trauma Centre” OR “Trauma unit” OR “Level 1 centre” OR “Level 2 centre” OR MTC ) AND TX ( Outcome OR Experience OR “Patient centred” OR Mortality OR Morbidity OR survival )

OVID
((Frail or Old or 'older person' or Geriatric or Frailty or silver) and ('major trauma' or 'silver trauma' or Trauma or polytrauma) and ('Major Trauma Centre' or 'Trauma unit' or 'Level 1 centre' or 'Level 2 centre' or MTC) and (Outcome or Experience or 'Patient centred' or Mortality or Morbidity or survival)).af

Search Outcome

649 papers with 5 of relevance

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

The comprehensive systematic review by Tonkins et all specifically addresses the 3-part question and notes that further research is required. This best bets review found no additional evidence strong enough to change or shape current UK practice.

Clinical Bottom Line

This topic would warrant further research

References

1. Elizabeth Brown, Hideo Tohira, Paul Bailey, Daniel Fatovich, Gavin Pereira, Judith Finn Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth
2. H Jarman, E Cole, R Crouch, M Halter, G Peck 734 ACUTE CARE PATHWAYS FOR OLDER MAJOR TRAUMA PATIENTS: A SURVEY OF UK PRACTICE
3. Michael Tonkins, Daniel Bradbury, Paul Bramley, Lisa Sabir, Anna Wilkinson, Fiona Lecky Care of the older trauma patient following low-energy transfer trauma —highlighting a research void
4. Van Ditshuizen, J.C., Van Den Driessche, C.R.L., Sewalt, C.A., Van Lieshout, E.M.M., Verhofstad, M.H.J. and Den Hartog, D., The association between level of trauma care and clinical outcome measures: A systematic review and meta-analysis. Journal of Trauma and Acute Care Surgery 2020 89(4), pp.801–812.
5. Tonkins, M., Bouamra, O. and Lecky, F. Association between major trauma centre care and outcomes of adult patients injured by low falls in England and Wales. Emergency Medicine Journal, 40(4), pp.257–263.