76GETTING AHEAD: AN AUDIT TO STANDARDISE MANAGEMENT OF TRAUMATIC BRAIN INJURY IN OLDER ADULTS

Abstract

Introduction: Traumatic brain injury (TBI) represents 45% of older adults admitted with major trauma1. The London Major Trauma System (LMTS) issued guidance in 2017 on the management of older people with TBI recommending admission under a surgical speciality, and assessment by a consultant geriatrician within 72 hours. It outlines geriatric domains for assessment e.g. delirium, dementia and nutrition. At Guy's and St Thomas's (GSTT) trauma unit patients should be admitted under the emergency general surgeons (EGS), supported by a geriatric liaison team (POPS). This audit aimed to establish whether these local and regional guidelines were being followed. Method(s): Cases were identified using a retrospective search of CTs performed between August 2017 and July 2018. Keywords included "fall", "fell" and "trauma", and diagnoses or descriptions of TBI. Electronic records of patients >=65 years old admitted to hospital with TBI were reviewed against the LMTS standards. Result(s): 25 older patients with TBI were admitted to St Thomas's. Median age 81 years (range 65-99 years). Most common mechanism of injury was fall from standing height (88%). A trauma call was instigated in 11%. No patients received a frailty score. Admitted teams were: EGS (39%), general medicine (29%), orthopaedics (12%) and geriatrics (8%). 89% of admissions were reviewed by a geriatrician medicine. 36% by a consultant geriatrician within 72 hours. 60% had dementia screening, 56% delirium screening and 40% nutrition assessment. Conclusion(s): At GSTT older adults are not being admitted under the agreed EGS pathway. This may reflect the well-established difficulty identifying trauma in older people, plus few receiving a trauma call and none a frailty score. Despite this, the majority of patients received geriatric input, but not necessarily from a consultant in a timely manner. Work is now being completed to refine identification of TBI in older patients in order to receive early comprehensive assessment.