Defining major trauma: a literature review

Area of Science:

• Trauma Care
• Geriatric Emergency Medicine
• Pre-hospital Medicine

Background:

• Major trauma in the elderly is increasing.
• Elderly patients may sustain severe injuries from low-energy events.
• Current major trauma definitions may not adequately apply to this demographic.

Purpose of the Study:

• To review existing definitions of major trauma.
• To assess the utility of these definitions in the pre-hospital setting.
• To propose an updated definition for major trauma in elderly patients.

Main Methods:

• Systematic literature search of CINAHL, Cochrane Library, and Web of Science.
• Inclusion of 121 articles for analysis.
• Examination of grey literature and cited references.

Main Results:

• Retrospective scoring systems like the Injury Severity Score (ISS) are common but have limited pre-hospital utility.
• Key pre-hospital indicators include fatal outcomes, injury patterns, and physiological derangement.
• Mechanism of Injury (MOI) is useful but should be considered with other factors.

Conclusions:

• Pre-hospital care requires definitions not reliant on retrospective scoring.
• A proposed definition includes fatal or significant injury with physiological derangement, irrespective of MOI.
• This definition also considers the predicted need for significant interventions like ICU admission or surgery.