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Abstract
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 association between major trauma centre (MTC) care and outcomes in adult patients injured by low falls.
Methods Data were obtained from the Trauma Audit and Research Network on adult patients injured by falls from <2 m between 2017 and 2019 in England and Wales. 30-day survival, length of hospital stay and discharge destination were compared between MTCs and trauma units or local emergency hospitals (TU/LEHs) using an adjusted multiple logistic regression model.
Results 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 OR (AOR) 0.91, 95% CI 0.87 to 0.96, p<0.001). Transferred patients had a significant impact on the results. After excluding transferred patients, MTC care was associated with greater odds of 30-day survival (AOR 1.056, 95% CI 1.001 to 1.113, p=0.044). MTC care was also associated with greater odds of 30-day survival in the most severely injured patients (AOR 1.126, 95% CI 1.04 to 1.22, p=0.002), but not in patients aged >65 years (AOR 1.038, 95% CI 0.982 to 1.097, p=0.184).
Conclusion MTC care was not associated with improved survival compared with TU/LEH care in the whole cohort. Patients who were transferred had a significant impact on the results. In patients who are not transferred, MTC care is 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, develop patient-focused outcomes which reflect the characteristics and priorities of contemporary trauma patients, and investigate the need for transfer in specific subgroups of patients.
- trauma
- accidental falls
- geriatrics
- major trauma management
Data availability statement
Data are available upon reasonable request. The data used in this study is available from TARN on reasonable request.
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Data availability statement
Data are available upon reasonable request. The data used in this study is available from TARN on reasonable request.
Footnotes
Handling editor Aileen McCabe
Twitter @MikeTonkins
Contributors MT and FL conceived and designed this work. MT performed data cleaning and analysis in conjunction with OB. MT drafted the article. All authors contributed to critical revision and final approval of this manuscript. FL is the guarantor of this work.
Funding MT is supported by a National Institute of Health Research Academic Clinical Fellowship.
Competing interests FL is the research director of the Trauma Audit and Research Network (TARN) at the University of Manchester.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
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