Utilisation of a Silver Trauma Screening Tool

4831
Lydia Wales, Camrun Shah, Andy Ketchin, Lindsay Jones
Royal Devon University Hospital Trust
Clinical Quality
CQ - Clinical Effectiveness
Major Trauma
View DOI

Abstract

Introduction

Significant injuries are often missed in patients over 65. This may reflect the perception that low-energy mechanisms are unlikely to cause injury, distracting injuries, communication barriers, or a combination of factors. Delayed fracture diagnosis adversely impacts patient outcomes.

A silver trauma screening tool was developed in line with new trust guidance. It recommends that all patients aged over 65 with a Rockwood Clinical Frailty Scale score >5 presenting following a fall undergo trauma screening on admission. The tool consists of shake (cervical spine fractures), rattle (rib fractures), rock (pelvic and hip fractures), and roll (vertebral fractures). Our aim was to increase awareness and use of this tool to support early injury identification and improve patient outcomes.

Methods

We collected survey responses assessing resident doctors’ perceptions of silver trauma and awareness and use of the screening tool. Additional planned interventions to improve uptake of the tool include informal teaching sessions for resident doctors, posters, and a dedicated silver trauma awareness week. We audited use of the screening tool and adherence to trust guidance before and after these interventions. Our aim was to achieve 50% usage of the screening tool.

Results

Our preliminary survey results showed that 75% of resident doctors considered identifying silver trauma patients important for improving outcomes; however, only 50% were aware of the defined cohort. Screening tool use was low, with only 25% reporting prior use.

A pre-intervention audit supports this, identifying 24 patients presenting to the acute medical unit following a fall. None had been screened using the silver trauma tool at initial clerking. Post-intervention data collection is planned.

Conclusions

Resident doctors recognise the importance of silver trauma but are not consistently identifying or screening patients. Our aim is to increase awareness and use of the screening tool to improve early injury identification and outcomes. 

Comments

Hi,

I like the idea of s quick screening tool but am interested to know how the assessment's are carried out.  Is this clinical exam only or are you including imaging?  Slightly anxious about the use of the words in the tool as well (sure it's just a handy mnemonic)- hopefully no body is actually rocking the pelvis....!

Submitted by catriona.walla… on

Permalink

Hi Catriona, thanks for your comment. 

So in the clinical guidance link at the bottom of our tool it has a full description of how to do the assessment as well as imaging advice including red flags. We appreciate your concern re. the wording, this is more to help remember the tool, the guidance suggests to "gently" rock the pelvis at the iliac crest to unmask pain. 

Our project is primarily focussed in our medical admissions unit currently and we are aiming to catch the patients who have come through without obvious injury and are focussed improving the recognition of injury at medical clerking.

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