TRAUMA IS THE OLD MAN´S DISEASE

Screen Shot 2015-12-07 at 11.44.46Traditional teaching is that trauma is the young male´s disease. Young males are exposed to accidents and violence. Young males also tend to engage in profoundly stupid activities. However, since a decade or so there is a shift. Major trauma in the elderly has become increasingly common. Authors have since long predicted that the elderly eventually will be the dominant demographic. A study in EMJ suggests that has already happened.

The study
A massive UK trauma database called TARN (Trauma Audit Research Network) was reviewed to identify all cases of major trauma (ISS > 15) between 1990 and 2013. Victims were then sorted into age groups. Common mechanisms of injury were analysed.

Results
In 1990 the mean age of patients suffering major trauma in the was UK 36,1 years.  39,3% of of patients were younger than 25 years. 8,1% of victims were older than 75 years.

Then, throughout the study period, mean age steadily increased.

In 2013 the mean age of victims was 53,8 years. Under-25s had decreased to 17%. The percentage of victims older than 75 years had exploded, increased three-fold and were now up at 26,9%.

During the study period the mechanisms of injury (MOI) had dramatically changed.

In 1990 road traffic collisions (RTCs) caused nearly 60% of major trauma while low fall (from <2m) accidents caused 4,7%. By 2013 low fall accidents had increased to 39,1% while RTCS had halved to under 30%.

Take-home message
In the UK it seems trauma no longer is the young man’s disease. Mean age of major trauma victims has increased from 36,1 to 53,8 years. The most common MOI in major trauma is no longer traffic accidents but falls from heights below 2m.

Possible explanations:

  • RTCs are no longer the dominant MOIs for major trauma victims.
  • Increase in numbers of older people in the general population.
  • Improved detection and reporting of trauma in the elderly.

Study lives here. Available for FREE and a must-read.

Emerg Med J. 2015 Dec;32(12):911-5. doi: 10.1136/emermed-2015-205265. The changing face of major trauma in the UK. Kehoe A1, Smith JE2, Edwards A3, Yates D3, Lecky F4.

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