The changing face of major trauma in the UK

TLDR

Major trauma has historically involved young men from high‑energy injuries, but ageing Western populations are expected to shift the burden toward older adults. This study aimed to describe how the demographics of major trauma in the UK have changed over the past 20 years. Using the Trauma Audit Research Network database, all major trauma cases (ISS > 15) from 1990 to 2013 were identified and analyzed for age, gender, injury mechanism, and CT use, with patients grouped into 25‑year age bands and common mechanisms to track yearly trends. The analysis revealed a marked shift: mean age rose from 36.1 to 53.8 years, the largest age groups moved from 0–24 to 25–50 and >75, road‑traffic collisions fell from 59.1 % to 39.1 % while low falls rose to 39.1 %, male proportion declined slightly, and CT usage increased from 33.6 % to 86.8 %, indicating an older, fall‑driven trauma population that may benefit from elder‑focused services.

Abstract

Aim Major trauma (MT) has traditionally been viewed as a disease of young men caused by high-energy transfer mechanisms of injury, which has been reflected in the configuration of MT services. With ageing populations in Western societies, it is anticipated that the elderly will comprise an increasing proportion of the MT workload. The aim of this study was to describe changes in the demographics of MT in a developed Western health system over the last 20 years. Methods The Trauma Audit Research Network (TARN) database was interrogated to identify all cases of MT (injury severity score >15) between 1990 and the end of 2013. Age at presentation, gender, mechanism of injury and use of CT were recorded. For convenience, cases were categorised by age groups of 25 years and by common mechanisms of injury. Longitudinal changes each year were recorded. Results Profound changes in the demographics of recorded MT were observed. In 1990, the mean age of MT patients within the TARN database was 36.1, the largest age group suffering MT was 0–24 years (39.3%), the most common causative mechanism was road traffic collision (59.1%), 72.7% were male and 33.6% underwent CT. By 2013, mean age had increased to 53.8 years, the single largest age group was 25–50 years (27.1%), closely followed by those >75 years (26.9%), the most common mechanism was low falls (39.1%), 68.3% were male and 86.8% underwent CT. Conclusions This study suggests that the MT population identified in the UK is becoming more elderly, and the predominant mechanism that precipitates MT is a fall from <2 m. Significant improvements in outcomes from MT may be expected if services targeting the specific needs of the elderly are developed within MT centres.