Article Text

Download PDFPDF
Silver Trauma Review Clinic: a novel model of care to manage non-operative injuries in older patients
  1. Hannah Smyth,
  2. Deirdre Breslin,
  3. Lorcán Mullany,
  4. Vinny Ramiah,
  5. Roisin Riches,
  6. Rico Laguna,
  7. Paula Morgan,
  8. Colm Byrne
  1. Departments of Emergency Medicine and Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
  1. Correspondence to Dr Hannah Smyth, Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland; hmsmyth{at}


Background Increasing numbers of older patients are presenting to the ED following trauma. These patients require multidisciplinary care that the traditional trauma model fails to provide. A Silver Trauma Review Clinic (STRC) was developed in conjunction with the geriatric ED and multidisciplinary services to improve the post-discharge care of patients with non-operative traumatic injuries.

We aimed to assess the STRC by reviewing the journey and outcomes of patients who attended the clinic.

Methods A retrospective review of electronic chart data was performed on all patients who attended the clinic over the initial 1-year period. Data were collected on patient demographics, medical history, medications, timelines, trauma assessments and further investigations, fracture types, occult injuries, geriatric assessments (Comprehensive Geriatric Assessment, Clinical Frailty Scale, bone health, falls, Orthostatic Hypotension (OH), cognitive screening, mobility), number of reviews and discharge destination.

Results 137 patients were reviewed with a median age of 80 years (IQR 74–86) and 69% were female. The median Clinical Frailty Scale was 3 with a median time from the patient’s initial ED presentation to clinic of 15 days (IQR 9.75–21) and median time from initial review to discharge 20 days (IQR 1–35). 71% of presentations were as a result of falls under 2 m. Tertiary survey in the STRC identified previously unrecognised injuries in 24 patients (18%). In total, 56 patients were reviewed with vertebral fractures. 87% of these patients (n=49) were further investigated with a CT or MRI and 95% of patients (n=53) were referred for physiotherapy. Patients attending the STRC had a comprehensive geriatric assessment with abnormal Mini-Cog assessments found in 29%, a new diagnosis of osteoporosis in 43% and orthostatic hypotension diagnosed in 13% of patients. 61% were discharged to primary care and 19% linked into a specialist geriatric clinic.

Conclusion The STRC is a novel approach allowing timely, patient-focused, comprehensive and collaborative trauma care of older patients following non-operative injuries.

  • trauma
  • admission avoidance
  • frailty
  • geriatrics

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, HS, upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, HS, upon reasonable request.

View Full Text


  • Handling editor Mary Dawood

  • Contributors All authors take responsibility for the content of the work submitted and have helped draft and review the manuscript. All authors were involved in the conception and design of the work. HS and LM performed the data collection. HS, LM and CB performed the data analysis and interpretation. HS, DB, LM and CB drafted the article. All authors were involved in critical revision of the article and all authors gave final approval of the version to be published. CB is the 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.