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Title: Identifying older major trauma patient characteristics and care process factors that impact on mortality : a mixed methods study
Author: Sammy, Ian
ISNI:       0000 0004 7651 7508
Awarding Body: University of Sheffield
Current Institution: University of Sheffield
Date of Award: 2019
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Background: As the global population ages, the presentation of major trauma has changed from healthy young men to older females with comorbidities. This study aimed to identify patient characteristics and care process factors that impact on mortality following major trauma in older patients. Methods: This was a sequential mixed methods study, using qualitative residual analysis. A model for predicting risk-adjusted mortality in older trauma patients was developed using data from the Trauma Audit and Research Network (TARN) on 46,000 patients aged ?65 years admitted with major trauma between June 2013 and May 2015. Hospitals with significantly better or worse survival rates than predicted by the model (outliers) were identified. Twenty semi-structured interviews were conducted with staff at two outlying hospitals, to identify factors that may have contributed to their outcomes. These were added to the predictive model to determine whether they explained the variance between hospitals. Results: The predictive model created performed better in older people than the current TARN predictive model. It included the covariates used in the current TARN predictive model, but the presentation of these variables differed. Interviews at outlying hospitals revealed three main themes: characteristics of older trauma patients, attitudes towards older trauma patients and management of older trauma patients. Important sub-themes included frailty, attitudes of older patients, attitudes of staff, the benefits of a trauma ward, a holistic approach and decisions to resuscitate. Admission to a trauma ward and ordering a rehabilitation prescription were associated with improved outcomes, but did not improve the accuracy of the model. Conclusion: Current models for predicting outcome in major trauma are not as accurate when applied to older patients. Factors identified as potentially important in this population included frailty, early rehabilitation, and the presence of a trauma ward in hospitals caring for these older patients.
Supervisor: Lecky, Fiona ; O'Cathain, Alicia Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available