Falls in the home leading cause of major trauma in Ireland

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Falls in the home were the leading cause of major trauma in Ireland during 2019 and 2020, according to Prof. Conor Deasy, Clinical Lead for Major Trauma Audit (MTA).

There was an increase in the proportion of major trauma patients who died from falls. The percentage of those who died from falls less than 2m increased from 59% in 2019 to 64% in 2020, while the percentage of those who died from falls more than 2m increased from 11% in 2019 to 16% in 2020.

 Prof. Deasy and Louise Brent, Major Trauma Audit Manager, were launching the Major Trauma Audit Report 2019-2020.

The report focused on patients who had suffered a major trauma accident over 2019 and 2020, with a focus on the early impact of the COVID-19 pandemic on trauma activity and care.

Falls in the home accounted for the majority of these injuries and presented an obvious opportunity for injury prevention, they said. From 2019-2020, data was collected on 8,764 cases from the majority of the 26 hospitals involved in the audit. Prof. Deasy said the report presented the first picture of how trauma activity, care and outcomes were affected during a very tumultuous time in the Health Service due to the COVID-19 pandemic. “The significance of this data can help to inform future public health strategies and the reconfiguration of the Trauma System when such events like a pandemic or cyber-attack occur.”

Prof. Deasy said the overall percentage of major trauma patients received by a trauma team remained extremely low, at 8% in 2019 and 9% in 2020. As patients got older they were less likely to be pre-alerted, met by a trauma team or received by a senior clinician. Both 2019 and 2020 had a low-level pre-alert rate of 12%. ‘Pre-alert’ is a system whereby the ambulance service communicates to the receiving hospital that it is bringing a patient to the emergency department (ED), the nature of the patient’s injuries, the patient’s physiology, their expected requirements on arrival, and the expected time of arrival.

The report said that patients should be triaged and reviewed in a timely manner by the relevant grade doctor according to their injuries.

In 2019, 22% and in 2020, 20% of patients with a major trauma were seen by a consultant on arrival. This difference between 2019 and 2020 was statistically significant. In both 2019 and 2020 younger major trauma patients were more likely to be seen by a consultant on arrival. In 2019, a consultant saw 10% of patients with major trauma within 30 minutes of arrival to the ED. In 2020, this decreased to 8%

Other key findings of the audit were:

  • Major Trauma Audit (MTA) data coverage was 83% in 2019 and 73% in 2020.
  • The mean age of major trauma patients increased from 58 years in 2019 to 61 years in 2020.
  • The percentage of falls of less than 2m increased from 58% in 2019 to 62% in 2020.
  • The proportion of patients injured at home increased from 48% in 2019 to 56% in 2020.
  • There was an approximately 10% reduction in the number of major trauma admissions during 2020, compared with 2019.

Louise Brent, Audit Manager MTA said, “The increase of falls in the home over the course of the first three waves of the pandemic shows us that there is a real opportunity for the public to use this information to ensure their homes are as safe as possible. Using the data on falls in the home we have designed a very quick checklist that anyone can use to identify common causes and risks that may be present in the home, the majority of which are easily remedied. Ireland has achieved a lot of improvement in the likes of road safety, we now must turn our attention to home safety as well.”

The report recommended that each hospital should establish a local MTA governance committee to ensure their local audit findings were acted on – this is in line with the guidance issued by the MTA.