The Victorian State Trauma System provides support and retrieval services for critically injured patients requiring definitive care, transfer and management. This older person trauma guideline provides advice on the initial management and transfer of major trauma patients who present to Victorian health services with severe injuries.
This guideline has been developed for all clinical staff involved in the care of trauma patients in Victoria. It is intended for use by frontline clinical staff that provide early care for major trauma patients; those working directly at the Major Trauma Service (MTS) as well as those working outside of a MTS, such as in regional or remote settings.
These guidelines provide the user with accessible resources to provide early care effectively and confidently for critically injured patients. The guideline is evidence based, has followed the AGREEII methodology for guideline development and is under the auspice of the Trauma System Advisory Committee (TSAC).1
Clinical Emphasis Points
There is an increasing incidence of trauma in older people, with a higher mortality and higher rate of complications.
Age is often regarded as the major factor in post-trauma mortality for this patient cohort.(2, 3)
Older trauma patients are a unique and growing patient population that requires consideration of their reduced physiological reserve and blunted response to injury. Physiological ageing, co-morbidities and polypharmacy are more common in older patients and may mask signs of shock as well as make assessment and initial management more challenging.(4)
Older patients are more susceptible to incidents of trauma, especially low energy or innocuous traumatic mechanisms which can lead to major injuries.
Assessment of older patients requires a multi-factorial approach as trauma may have been precipitated by a new medical event, underlying co-morbidities, and overall frailty.
A higher index of suspicion of injury should be maintained. Vital signs may be falsely reassuring due to co-morbidities such as hypertension and may not reflect severity of injury.
Collaboration with family and general practitioners will help to aid a comprehensive functional, medical and prescribed medication history.
Established advanced care plans and goals of care should be integrated into management strategies. Patient-centred care should aim to preserve or improve Quality of Life, not simply extend Quantity of Life.