Background The mean and median age of major trauma continues to increase for a mean of 36 years in the 1990's to 59 and 61 years respectively in 2016 and 2017. The age planning of major trauma has important implications for healthcare planning. Methods The major trauma audit was established by the National Office of Clinical Audit (NOCA) in 2013 and focuses on the most severely injured trauma patients in our healthcare system. The methodological approach is provided by the Trauma Audit and Research Network (TARN). Since 2016 all 26 eligible hospitals have been participating in the audit and the coverage is now 86%.Data has been collected on more than 15000 trauma patients to date. Results There were 5061 recorded major trauma cases of which 2233 (44%) were over 65 years in 2017. The most common form of injury (57%) was falls less than two metres (low falls) and this began aged 45 years. 50% of injuries occurred in patient's own home. Only 11% of people were received by a trauma team and this was even lower in the older adult. Older people were very unlikely to be pre-alerted to the Emergency Department prior to arrival. 64% of the mortality from major trauma occurred in the over 65 years. 6%, 7% and 10% of patients aged 65-74, 75-84 and over 85's respectively were discharged directly to nursing home. Conclusion There is a marked change in the age profile sustaining major trauma since the late 1990's. Patients today are older with more complex medical needs, have greater lengths of stay and many do not return to independent living. The most common mechanism of injury for older people is a low fall at home. We need to prevent low galls using a multidisciplinary, multi-agency approach.

Abtract In 2016, 3,610 patients over the age of sixty were hospitalised with a hip fracture in Ireland. The acute hospital care costs are in excess of €45 million and growing. This doesn’t include the long term costs of rehabilitation, convalescence, community care and long term care. The IHFD is a clinically led, web based audit of hip fracture casemix, care and outcomes. It is supported by the Irish Gerontological Society (IGS) and the Irish Institute of Trauma and Orthopaedics (IITOS) and the National Office of Clinical Audit (NOCA) provides governance and operational support for the IHFD. All sixteen eligible hospitals in the Republic of Ireland are included. The most recent IHFD report 2015 published in 2016 is comprised of data from 2,962 hip fracture cases from 16 hospitals. The coverage of the data for 2015 was 81%. The mean length of stay was 20 days and the median length of stay was 13 days in 2015. The 2016 report will be published later this year. Preliminary data for 2016 shows the coverage has increased to 86.5%. In the 2015 National report published in 2016 70% hip fractures were female, 83% patients were admitted from home and 48% were independently mobile, 37% fractures were intracapsular displaced, 36% of arthroplasties were cemented and 30% patients were discharged directly home. Thirty-nine percent (39%) of patients were reviewed by a geriatrician at any time during their admission. The proportion of patients being reviewed pre-operatively is 15%. In 2017, the focus continues to be on improving data quality and increasing coverage nationally to 100% for all sites. To ensure all suspected hip fracture patients should be brought directly to the trauma operating hospital. Each hospital should establish a hip fracture working group to review and utilise the IHFD data locally to improve patient care.

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