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Volume 23 Supplement 2

London Trauma Conference 2014

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‘Silver’ trauma: predicting mortality in elderly major trauma based on place of injury


Elderly trauma now accounts for more than 20% of UK major trauma [1]. Clearly, elderly trauma patients are at increased risk of morbidity and mortality, but outcome can be difficult to predict. Current evidence is limited to correlations between poor outcome and complex, difficult-to-calculate pre-morbid frailty indices [2]. A simple, evidence-based prognostic marker is needed to guide early management. We hypothesised that elderly patients suffering severe injury at home indoors are frailer, and therefore more likely to succumb to their injuries, than those injured outdoors.


All patients admitted to a London major trauma centre in 2013 aged ≥65 years old with an Injury Severity Score (ISS) >15 were identified using Trauma Audit & Research Network data. Patient demographics, date of death, and injury location (‘at home indoors’ or ‘outside the home’) were recorded and mortality rates compared.


124 patients were included (M:F = 1.4:1). 58 patients (46.8%) were injured at home indoors; 66 patients (53.2%) outside the home. The groups were equivalent in age (p=0.44) and ISS (p=0.52). 6-month mortality among patients injured at home indoors was 36.2%, nearly double that of patients injured outside of the home (18.2%) (p=0.0267).


Our study found significant correlation between injury location and mortality, suggesting that severe injury inside the home could represent a rough marker of frailty, and therefore, outcome. This could have important implications for prognosticating elderly patients in the resuscitation room, where quick management decisions need to be made by clinicians, patients and relatives. Further studies are needed to evaluate pre-morbid frailty of both groups and to assess functional outcome of survivors.


  1. National Confidential Enquiry into Patient Outcome and Death. Trauma: Who cares?. 2007

  2. Joseph B, et al: Validating trauma-specific frailty index for geriatric trauma patients: a prospective analysis. J Am Coll Surg. 219 (1): 10-17.

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Correspondence to Susan A Hendrickson.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Hendrickson, S.A., Osei-Kuffour, D., Aylwin, C. et al. ‘Silver’ trauma: predicting mortality in elderly major trauma based on place of injury. Scand J Trauma Resusc Emerg Med 23 (Suppl 2), A4 (2015).

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