Silver trauma dilemma: fall from standing height.

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. One standard MOI is fall > 3 metres and one standard patient characteristic is age > 55 years. While patient characteristics include ‘significant comorbidity’ this does not include use of anticoagulants. Anecdotally, significant injuries are known to occur in more elderly patients following falls from standing height, particularly when the patient is on anticoagulants. Whether or not the size of this problem warrants a more formal revision of trauma response guidelines is unclear. 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 cases of fall from standing heights for different age categories. Audit will note: level of trauma response, triggering criteria, incidence of major trauma diagnoses, time to diagnosis and outcome. This will quantify the approach to the silver trauma patient falling from a standing height. If delays to significant diagnoses are identified and appear associated with lack of a trauma response, this will inform adjustment of the current trauma response guidelines. Two particular variables of interest will be the need for repeat CTB especially if the patient is on anticoagulants and the likely utility of an early whole-body CT. 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. 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.