Aims, Objectives and Background Disability and death due to low falls is increasing worldwide and disproportionately affects older adults. Current trauma systems were not designed to suit the needs of these patients. This study assessed the effectiveness of major trauma centre care in adult patients injured by low falls.
Method and Design Data were obtained from the Trauma Audit and Research Network on adult (age >16 years) patients injured by falls from <2 metres between 2017–2019 in England and Wales. Binary logistic regression and Cox Regression were used to control for casemix. 30-day survival, length of hospital stay and discharge destination were compared between major trauma centres (MTCs) and trauma units or local emergency hospitals (TU/LEHs).
Results and Conclusion 127,334 patients were included of whom 27.6% attended an MTC. The median age was 79.4 years (IQR 64.5–87.2 years), and 74.2% of patients were aged >65 years. MTC care was not associated with improved 30-day survival (adjusted odds ratio [AOR] 0.91, 95% CI 0.87–0.96). Transferred patients had a significant impact upon the results. After excluding transferred patients, the AOR for survival in MTCs was 1.056 (95% CI 1.001–1.113). The association between improved survival and MTC care was greatest in patients who suffered major trauma (AOR 1.126, 95% CI 1.044–1.215) and was absent in patients aged >65 (AOR 1.038, 95% CI 0.982–1.097).
TU/LEH care is at least as effective as MTC care due to the facility for secondary transfer from TU/LEHs to MTCs. In patients who are not transferred, MTCs are associated with greater odds of 30-day survival in the whole cohort and in the most severely injured patients. Future research must determine the optimum means of identifying patients in need of higher-level care, the components of care which improve patient outcomes, and develop patient-focused outcomes which reflect the characteristics and priorities of contemporary trauma patients.
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