The Effect of Increasing Age on Outcomes in Major Trauma: A Retrospective Cohort Study

OBJECTIVE: To investigate the impact of increasing age on clinical outcomes in major trauma patients. Primary outcomes assessed included time to diagnostic imaging, length of hospital stay, and mortality rates both in-hospital and at 30 days post-injury. METHODS: A retrospective observational study was conducted involving major trauma patients presenting to a tertiary referral centre over a 6-year period, 2017-2023. The effect of increasing age on triage, investigation and management, and clinical outcomes, including length of stay and mortality, was examined. RESULTS: Analysis demonstrated that the likelihood of trauma team activation decreased with increasing age, independent of injury severity score. Increasing age was a significant predictor of in-hospital mortality (odds ratio: 1.06, 95% confidence interval: 1.05-1.07). Rates of computed tomography (CT) utilisation were comparable between older and younger cohorts (≥ 65 vs. < 65 years, 94.8% vs. 94.9%); yet, older patients experienced significantly longer median wait times for imaging (130 min [≥ 65] vs. 79 min [< 65]). CONCLUSIONS: Increasing age is associated with decreased trauma team activation rates irrespective of injury severity. Furthermore, older trauma patients exhibit substantially higher mortality rates, with a marked increase observed beyond initial hospital discharge. Age-specific trauma team activation criteria may reduce under-triage and potentially improve outcomes in older patients.