Service evaluation: Factors associated with missed or delayed diagnosis of major trauma in older people at a UK level 1 trauma centre

Diagnosis of major trauma in the older person is increasingly being recognised as clinically challenging when compared to that of the younger patient. Recent reports state that older patients sustaining major trauma are commonly under-recognised and are subsequently not receiving gold standard major trauma care. This paper reports a service evaluation of major trauma (ISS >15) care in patients >65 years presenting to the emergency department (ED) at a UK major trauma centre (MTC). Multiple logistic regression suggests that there are modifiable process factors that have a statistically significant association with missed or delayed diagnosis of major trauma. Lack of trauma team activation, CT imaging and assessment in pitstop vs the resuscitation room were associated with missed or delayed diagnosis of major trauma. These findings suggest that service improvement initiatives should be aimed at the early stages of the patient journey to improve missed or delayed diagnoses of major trauma in this patient group