Silver trauma dilemma: the ‘routine’ whole body CT.

Current peak body guidelines for a hospital trauma response generally follow a three-tiered hierarchy. Trauma responses are indicated for trauma patients (any mechanism) if abnormal vital sign criteria are met or if serious injury is suspected in two or more body regions. Response to the third level of mechanism of injury (MOI) and patient characteristics is more variable and may include a more limited (ED-based) trauma response. Currently, the majority of adult patients meeting vital sign and injury pattern criteria have a whole-body CT (WBCT). When only MOI criteria are present, obtaining a WBCT is more selective. Some expert consensus guidelines suggest that in ‘silver trauma’ (adults aged over 65 years), WBCT for all/any MOI may be the standard of care, since the elderly suffer more serious trauma from ‘lesser’ intensity traumas than do younger people. More frequent use of anticoagulant medication in this population is thought to be another contributing factor. Literature on either the current approach to WBCT in silver trauma, or its utility is limited. Stage 1: Literature search and summary on major trauma occurrence in the elderly following falls from standing height (+/- anticoagulation). Stage 2: Retrospective audit of local trauma call cases noting: level of trauma response, triggering criteria, obtaining of WBCT, incidence of major trauma diagnoses, time to diagnosis and outcome. This will quantify the approach to WBCT in silver versus non-sliver trauma patients and detect delayed significant trauma diagnoses. This will inform on needed adjustment of the current trauma management guidelines to possibly include WBCT for a wider range of MOI than for younger trauma patients. Stage 3: If guidelines are to be adjusted, study protocol for a pre and post-intervention observational study will be developed and submitted to the ethics committee as a quality improvement project. Note: The 2023 project is expected to conclude at this point. Stage 4: Following guideline update the same outcomes will be monitored in an ongoing way. After appropriate recruitment, analysis will be conducted and a report prepared.