Evaluation of interventions for trauma care in older adults: a consensus study.

backgroundTrauma care of older adults is an important and growing public health issue. Countries such as the United States and United Kingdom have published best-practice guidelines on the management of older trauma patients. In Australia, there are no such guidelines. Australian guidelines are needed as there are unique contextual challenges, including low population density and large distances between the site of injury and where treatment is administered.

aimsTo determine which interventions for managing older trauma patients should be prioritised for inclusion in national guidelines.

methodsA consensus method with two survey rounds was conducted with a range of health professionals involved in delivering trauma care for older adults. In round 1, participants were asked which of 28 interventions should be included in national guidelines. Consensus was defined as ≥80% agreement. In round 2, participants ranked interventions in order of priority for inclusion in guidelines. Interventions were classified into pre-hospital care, in-hospital initial assessment, inpatient care, transition care and education.

resultsA total of 32 and 25 participants completed rounds 1 and 2 of the survey respectively. Of 28 interventions proposed for national guidelines, 15 reached consensus. Key priority interventions included geriatric-specific triage, documented goals of care, trauma team activation criteria, multidisciplinary geriatric care and training modules in older trauma care.

conclusionsThis study identified 15 interventions that trauma clinicians agreed should be considered for inclusion in guidelines for the management of older adult trauma. Given the burden of older adult trauma, a national consensus guideline should be prioritised and a working group formed.