A study carried out by doctors at University Hospital Galway (UHG ) has revealed the changing presentation of trauma patients, with a doubling of cases and older patient profile emerging over the course of a decade.
Based on critical care data from UHG, the study looked at the characteristics of trauma patients, the nature of their injuries and trends in mortality rates over a 10 year period.
709 major trauma patient admissions between 2010 and 2021 were reviewed as part of the study (major trauma is defined as serious injury with the potential of causing death and disability ).
Dr Ciara Hanley, UHG Consultant Anaesthesiologist and lead author of the study said; “Trauma remains one of the commonest causes of death and disability worldwide. Over the last decade, we have seen a significant change in the pattern and demographic of major trauma presenting to our centre, and in those requiring critical care input.”
In the 10 year period, trauma cases doubled and patients aged 65 and older accounted for 45.7% of all admissions. Within this older cohort, 47.5% of patients are aged 80 and over. The study found that the majority of these older patients had good outcomes overall; most of them underwent surgical intervention and were discharged from critical care within 48 hours.
• 97.6% of cases had blunt force trauma injuries caused by either a fall (45.4% ) or road traffic accident (29.2% )
• Orthopaedic, thoracic and spinal trauma were the most frequent organ systems injured (53%, 37% and 32.5% respectively )
• Admissions are predominately male, with an overall mean of 68.4%
• Frailty has a significant adverse impact in older patients including increased 30-day mortality, increased incidence of complications, delayed discharge, and increased readmission rates
The study highlights the high quality specialist care delivered by the critical care team in UHG which is a designated TUSS (Trauma Unit with Specialist Services ). A total of 400 patients underwent surgical treatment at our regional site and only 51 patients required an inter-hospital transfer for specialist management not provided in UHG.
Dr Alan Hussey, Clinical Director of Saolta’s Perioperative Directorate stated; “This data shows the volume and complexity of trauma work that University Hospital Galway manages. Our clinical teams are providing an essential, life-saving service for the entire region while managing an increasing caseload.”
Chris Kane, GUH Hospital Manager said; “The study contains many useful learnings for us as we strive to deliver excellence in trauma care in light of a changing demographic and an increasing incidence of older patients who can have multiple and complex care needs. It is also important to acknowledge the incredible work being carried out by our critical care team who are seeing a sustained increase in demand over recent years.”
Speaking about the national trauma system Dr Hanley said; “University Hospital Galway plays a pivotal and unique role within the trauma network in Ireland. The Major Trauma Audit National Report in 2018 led to the transformation of structures and processes in relation to trauma management in Ireland, deliver a national high-quality graded hub-and-spoke network of trauma services in line with international best practice.
“A key factor in the success of the trauma network will be the appropriate and timely funding and resourcing of University Hospital Galway to enable it to continue to provide high quality trauma care in line with international best practice. This not only facilitates equity of access to trauma care services, but also maintains the high volume practice, and clinical expertise within the region.”
Prof John Laffey, UHG Consultant in Anaesthesia and Intensive Care Medicine concluded; “As a Trauma Unit with Specialist Services, our hospital is uniquely positioned to deliver exceptional care, despite the challenges posed by our extensive catchment area and the prolonged transfer time to the Major Trauma Centre. The doubling of critical care trauma admissions over the past decade underscores the increasing demand for our services, particularly among older adults.”
