The changing major trauma disease burden from low falls in the first two decades of the 21st Century – a longitudinal analysis from the largest European Trauma Registry

Abstract

Objective

The 21st century has seen an unexpected rise in numbers of patients with severe injuries caused by low energy transfer mechanisms such as low falls. Our objective was to determine whether this increasing “low energy transfer major trauma” disease burden is more strongly associated with population ageing, better detection or registry reporting between 2000 and 2019.

Design

Longitudinal series of annual cross-sectional studies from the Trauma Audit Research Network (TARN).

Setting

England and Wales.

Participants

Patients with an Injury Severity score (ISS) >15, admitted to English or Welsh hospitals from January 2000 until December 2019.

Main outcome measures

The primary outcome was the strength of association of changes in annual rates of; major trauma patients receiving three-dimensional imaging (CT/MRI scans), registry reporting, and proportion of the population aged over seventy-five with changes in the annual proportion of patients injured via low energy transfer mechanisms.

Results

The annual proportion of major trauma patients injured by low energy transfer mechanisms rose more than four-fold from 12.5% in 2000 to 52.6% in 2019 (+40.1%, 95% CI 38.8 to 41.4, p<0.0001). This rise in the prevalence of low energy major trauma was more strongly associated with case ascertainment improvements over the study period - indicated by a 60% increase in the proportion of major trauma patients receiving CT/MRI (+60%), and 47% increase in registry reporting rates than a one percent rise in the prevalence of people aged 75 years and over in England and Wales.

Conclusion

Between 2000 and 2019 changes in major trauma imaging and reporting have revealed the previously hidden burden of injury resulting from low energy transfer mechanisms, potentially explaining significant increases in major trauma patient numbers. Future research should recognise low energy and high energy major trauma patients are distinct groups and require different interventions to improve patient outcomes.

Section 1: What is already known on this topic

• Falls from standing height or less than two metres are causing an increasing major injury disease burden across Europe.

• Internationally trauma systems have focussed on patients with injuries caused by high energy transfer mechanisms, such as road traffic collisions.

Section 2: What this study adds

• Better detection and reporting of low energy transfer major trauma - rather than population ageing - appear to be are driving the increase in lower energy major trauma.

• Low energy transfer major trauma - characterised by older age, less abnormal physiology, but a high prevalence of traumatic brain and thoracic injuries - is now the dominant major trauma (ISS>15) presentation in England and Wales.

• Low energy transfer major trauma patients wait longer for CT scan, are less likely to receive the care in the highest-level trauma centre, to undergo surgery or be admitted to critical care.

Section 3: How this study might affect research, policy and practice

• Future research should recognise high energy and low energy trauma patients are distinct groups, which require different interventions to improve care processes and outcomes.