Evaluate Silver Trauma Risk Factors in Older People Undergoing CT Polytrauma

Introduction
Older people are at increased risk of significant injury following low-energy trauma and may present without physiological compromise. This can lead to under-recognition of injury and delayed management.  The Norfolk and Norwich University Hospital (NNUH) Emergency Department uses an adopted Silver Trauma triage tool incorporating multiple clinical risk factors to guide senior review and CT polytrauma imaging. However, the predictive value of individual risk factors within this tool remains uncertain. This project aimed to evaluate the performance of individual risk factors in predicting significant injury on CT imaging and to inform local service improvement.

Methods
A retrospective review was conducted of patients aged ≥65 years who underwent CT polytrauma following a traumatic presentation to the NNUH Emergency Department between September and November 2025. The Silver Trauma triage tool includes risk factors such as inability to straight leg raise, inability to cough or inhale deeply, severe pain, anticoagulant use, osteoporosis or prescribed bone protection, GCS <15 including baseline, sBP <110 mmHg, HR >90, lactate >2 and base excess <-2. Two outcomes were assessed: (1) presence of any acute traumatic injury on CT and (2) presence of multi-body region injury (≥2 anatomical regions). Each risk factor was recorded as a binary variable (yes/no) and analysed using 2x2 contingency tables to calculate sensitivity, specificity and estimated area under the curve (AUC).

Results
No individual Silver Trauma risk factor demonstrated strong discriminatory performance when assessed in isolation. For prediction of any acute traumatic injury on CT, the highest estimated AUC values were observed for lactate >2 (0.68), sBP <110 mmHg (0.66), and inability to cough or deeply inhale (0.65), although all showed relatively low sensitivity. For prediction of multi-region traumatic injury, sBP <110 mmHg showed highest estimated AUC (0.63), followed by inability to straight leg raise (0.58) and GCS <15 (0.56). Overall, the estimated AUC values were low across both outcomes, suggesting that individual risk factors had limited value as standalone predictors.

Conclusion
Individual components of the Silver Trauma triage tool demonstrated limited standalone discriminative ability. These findings support Silver Trauma assessment as a combined multi-parameter approach rather than reliance on a single risk factor and may help inform future local quality improvement work.