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Undertriage of the elderly major trauma patient continues in major trauma centre care: a retrospective cohort review
  1. Antonia C Hoyle1,
  2. Leela C Biant2,
  3. Mike Young3
  1. 1 Trauma and Orthopaedics, Health Education England North West, Manchester, UK
  2. 2 Trauma and Orthopaedic Surgery, University of Manchester, Manchester, UK
  3. 3 Trauma Audit and Research Network (TARN), University of Manchester, Manchester, UK
  1. Correspondence to Dr Antonia C Hoyle, Trauma and Orthopaedics, Health Education England North West, Manchester M1 3BN, UK; a.c.hoyle{at}


Background Major trauma (Injury Severity Score (ISS) ≥16) in older people is increasing, but concerns persist that major trauma is not always recognised in older patients on triage. This study compared undertriage of older and younger adult major trauma patients in the major trauma centre (MTC) setting to investigate this concern.

Methods A retrospective review of Trauma Audit and Research Network data was conducted for three MTCs in the UK for 3 months in 2014. Age, ISS, injury mechanism and injured areas were examined for all severely injured patients (ISS ≥16) and appropriate major trauma triage rates measured via the surrogate markers of trauma team activation and the presence of a consultant first attender, as per standards for major trauma care set by National Confidential Enquiry into Patient Outcomes and Deaths, Royal College of Surgeons of England and the British Orthopaedic Association. Trends in older (age ≥65) and younger (ages 18–64) adult major trauma presentation, triage and reception were reviewed.

Results Of 153 severely injured patients, 46 were aged ≥65. Older patients were significantly less likely to receive the attention of a consultant first attender or trauma team. Similar trends were also seen on subgroup analysis by mechanism of injury or number of injured body areas. Older major trauma patients exhibit a higher mortality, despite a lower median ISS (older patient ISS=20 (IQR 16–25), younger patient ISS=25 (IQR 18–29)).

Conclusion Older major trauma patients are at greater risk of undertriage, even in the MTC environment. Existing hospital trauma triage practices should be further investigated to explain and reduce undertriage of elderly trauma patients.

  • trauma
  • triage
  • geriatrics

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  • Handling editor Ellen Weber

  • Contributors Planning, conduct and reporting of the work described in the article was undertaken by ACH, with additional reporting of the work undertaken by LCB, and data supplied by MY. ACH takes responsibility for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Specific ethical approval beyond permission for TARN data was not sought as this study was a retrospective review of existing data, without patient contact or intervention.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Raw data can be obtained on request from Trauma Audit and Research Network.