The changing major trauma disease burden from low falls in the first two decades of the 21st Century; a longitudinal analysis from the largest European Trauma Registry

Abstract

Objective: The 21st century has seen an unexpected rise in numbers of patients with severe injuries caused by low energy transfer mechanisms such as low falls. Our objective was to determine whether this increase in low energy transfer major trauma disease burden is more strongly associated with population ageing, better detection or registry reporting between 2000 and 2019. Design: Longitudinal series of annual cross-sectional studies from the Trauma Audit Research Network (TARN). Setting: England and Wales. Participants: Patients with an Injury Severity score (ISS) >15, admitted to English or Welsh hospitals from January 2000 until December 2019. Main outcome measures: The primary outcome was the strength of association of changes in annual rates of; major trauma patients receiving three-dimensional imaging (CT/MRI scans), registry reporting, and proportion of the population aged over seventy-five with changes in the annual proportion of patients injured via low energy transfer mechanisms. Results: The annual proportion of major trauma patients injured by low energy transfer mechanisms rose more than four-fold from 12.5% in 2000 to 52.6% in 2019 (+40.1%, 95% CI 38.8 to 41.4, p<0.0001). This rise in the prevalence of low energy major trauma was more strongly associated with case ascertainment improvements over the study period - indicated by a 60% increase in the proportion of major trauma patients receiving CT/MRI (+60%), and 47% increase in registry reporting rates than a one percent rise in the prevalence of people aged 75 years and over in England and Wales. Conclusion: Between 2000 and 2019 changes in major trauma imaging and reporting have revealed the previously hidden burden of injury resulting from low energy transfer mechanisms, potentially explaining significant increases in major trauma patient numbers. Future research should recognise low energy and high energy major trauma patients are distinct groups and require different interventions to improve patient outcomes.

Competing Interest Statement

All authors have completed the ICMJE uniform disclosure form atwww.icmje.org/coi_disclosure.pdf and declare: TARN part remunerates FL, TC and DK in their roles as Research Director, Chair and Audit Director, respectively. AE and LW are full time employees of TARN (Executive and Operations Directors). Participating NHS Trusts funds TARN. TS and MT, academic clinical fellowships are funded by Health Education England (HEE) / NIHR for this research project. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care. no other relationships or activities that could appear to have influenced the submitted work.

Funding Statement

TARN part remunerates FL, TC and DK in their roles as Research Director, Chair and Audit Director, respectively. AE and LW are full time employees of TARN (Executive and Operations Directors). Participating NHS Trusts funds TARN. TS and MT, academic clinical fellowships are funded by Health Education England (HEE) / NIHR for this research project. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care. no other relationships or activities that could appear to have influenced the submitted work. All authors are independent from funders and that all authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis is also required.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

TARN holds UK Health Research Authority Confidentiality Advisory Group approval for analysis of anonymised patient data - Section 251 NHS Act (2006).

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Yes

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Data Availability

Data cannot be shared as both: (i) the Data Sharing Agreements established between the TARN and member NHS Trusts, and (ii) the Section 251 HRA approval for analysis of anonymized TARN data specify the need for data access agreements with third parties. Proposals to access the study data, data dictionary, analytic code, and analysis scripts may be submitted online via www.tarn.ac.uk. Proposals are subject to review by the TARN Research committee. A Data Transfer Agreement is required, and all access must comply with TARN HRA approval.

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