The Silver Trauma Review Clinic: A novel model of care to manage non-operative injuries in older patients

Abstract

BackgroundIncreasing numbers of older patients are presenting to emergency departments(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 and examining new diagnoses and interventions.MethodsA retrospective review of electronic chart data was performed on all patients who attended the clinic over the initial 1 year period.Results137 patient were reviewed with a median age of 80(IQR 12.5), 69% 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 11.25) and median time from initial review to discharge 20 days(IQR 34). 71% of presentations were as a result of falls under 2 metres. Primary injuries were 34% vertebral fractures, 45% limb fracture, 18% thoracic trauma, 11% pelvic trauma with 15% of patients suffering from multiple injuries. 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, 19% linked into a specialist geriatric clinic.ConclusionThe STRC is a novel approach allowing timely, patient focused, comprehensive and collaborative trauma care of older patients following non-operative injuries.

What effect did the New Zealand COVID‐19 lockdown have on computed tomography‐head scan utilisation in patients presenting to the emergency department with traumatic head injuries?

“…This is particularly the case for the elderly, the increasingly recognised at risk 'Silver Trauma' cohort. 19 Those over 65 years accounted for over 40% of included patients in 2019 and 50% during the lockdown in 2020. Falls are the leading cause of ED presentations in patients aged over 65 years and this disease burden is likely to increase given the global trend toward an ageing population.…”

“…The home environment contributes significantly to the burden of TBI and it is not solely sporting, high‐speed or high‐impact activities that carry TBI risk. This is particularly the case for the elderly, the increasingly recognised at risk ‘Silver Trauma’ cohort 19 . Those over 65 years accounted for over 40% of included patients in 2019 and 50% during the lockdown in 2020.…”

Variation in ambulance pre-alert process and practice: Cross-sectional survey of ambulance clinicians

“…Older trauma patients have complex presentations and benefit from early review from a geriatrician. (17) Therefore additional guidance for prehospital clinicians may facilitate earlier identification and therefore treatment of silver trauma.…”