A pragmatic appreciation of major trauma: defining major trauma and early identification of the older adult at risk of mortality from trauma

Thompson, Lee (2022) A pragmatic appreciation of major trauma: defining major trauma and early identification of the older adult at risk of mortality from trauma. Doctoral thesis, Northumbria University.

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Abstract

The existing literature within the field of trauma care originates primarily from an in-hospital focus. There is no global definition of major trauma or relevant trauma triage tool that can be applied in the prehospital phase of care to help early identification of those older adults at risk of mortality from low energy mechanisms of injury who may benefit from early consultant level assessment and ongoing management. Both of these issues are problematic to prehospital clinicians as well as clinicians who work in the emergency department and this thesis sought to address these questions.
An exploratory study to identify prehospital factors associated with outcomes for major trauma patients in a regional trauma network identified candidate variables (Glasgow Coma Score, respiratory rate and age) that provided the foundations of the entire thesis. Critical analysis and synthesis of the existing literature added further domains and issues worthy of critical consideration which included frailty, comorbidities, medications, male gender, injury patterns, ventilatory support, Body Mass Index and acidosis. Subsequently, a series of linked studies applied a mixed-method approach that variously sought to define major trauma from lived experiences of practitioners, gauge the extent to which consensus existed amongst trauma practitioners, and eventually resulted in the tentative formulation of indices for identifying the older adult at risk of mortality from trauma who may benefit from consultant level assessment. A Dynamic Pattern Synthesis analysis accentuated the complexity of trauma in older adults. Collectively, the outcomes of these studies provided an original, elegant and pragmatic definition of major trauma.
“Perceived significant injury or injuries that have potential to be life-threatening or life-changing sustained from either high or low energy mechanisms which also considers the complexities encountered by the extremities of age”.
This thesis concludes by offering a tentative predictive model for use in identifying those older adult trauma patients with a high risk of mortality and a prototype triage tool - the Northumbria Low Energy Trauma Score (NLETS). It is hoped that this model will prove of practical utility to all practitioners operating in a prehospital environment.

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