ThP7.5 - District General Hospital Management of Chest Trauma in Frail Adults: A Need for National Guidelines for Frailty in General Surgery

Abstract Annually, 16,000 adults face chest trauma, with blunt injuries in the elderly leading to high mortality rates. In TARN Chest trauma ranks as the second deadliest trauma in older adults, following head injuries. There's significant inconsistency, nationally, in the General Surgical management of these patients. Aims This study evaluates outcomes at a DGH to establish a basis for national guidelines Methods Single centre retrospective review of patients over the age of 65 presenting with chest trauma from Jan 2022 to Jan 2023. Results 114 Patients were included. Median age was 81 with a male predominance of 57.9%. Mortality was 17/109 (15.6%). Mechanisms of injury were fall from standing height (71.9%), fall from height >2m (18.8%) and RTA 9.3%. Median Rib fractures sustained were 4 (range 0 - >10). 51.8% of the patients had an associated pleural injury, 14 patients required a drain. 70 (61.4%) had isolated chest injuries, 29 (25.4%) had one other injured body region and 15 (13.2%) had three or more injured body regions. Median STUMBL score was 25 (9 – 52), 42.6% had a score of ≥ 27. 16.4% of patients were vulnerable and 51% were frail. Median Charlson co-morbidity index was 5 (range 2-11). 39% of patients had timely Geriatric review during admission and 14% were not referred. Conclusion DGH General Surgery teams admit high volumes of frail patients with chest trauma. Nationally there is an absence of general surgery chest trauma guidance (BOASTs now archived). These patients are complex requiring early support from Geriatricians to guide the goals of care. Careful consideration should be given to referral pathways, MDT and priorities of care.