Older Person's Trauma Care in an MTC ED: Two-Tiered Care. Is Perceived Lower Acuity the Problem?

Introduction:  

This process mapping compared the ED journey of patients aged ≥65 years with those <65 years presenting to the Royal Sussex County Hospital (RSCH), the Major Trauma Centre for Sussex.  

Methods:  

We conducted a retrospective snapshot audit of adult trauma patients (stratified into ≥65 and <65 year groups) presenting to RSCH ED September–October 2025. Eligible cases were identified via the local Trauma Database (Panda). Comparative statistical analysis was performed using Welch’s ANOVA. 

Results:  

Ninety patients were included (45 aged over 65 years; 45 aged under 65 years). Older adults were less frequently pre-alerted (23% vs 62%) and less likely to have a trauma call activated despite use of an older person trauma triage tool (51% vs 73%).  

80% of those over 65 years had an ISS score greater than 9, indicating a large proportion of older patients had moderate or severe traumatic injuries.  

Older adults had significantly longer total ED length of stay than younger patients (22.16 vs 10.42 hours; mean difference 11.74 hours; F(1,68.29)=25.05, p<0.001).  

They moved through more ED locations (median 3 [range 2–7] vs 2 [1–5]) and spent longer in ED corridor care. They experienced longer median times to clinician assessment (53 vs 11 minutes) and time to imaging requests (84 vs 24 minutes). Only 30% received a Geriatric review in the ED despite a median stay of 22 hours.  

Discussion: 

Older trauma patients experienced longer and more complex ED journeys. The statistically and clinically significant difference in ED length of stay, despite a high burden of moderate to severe injury in older patients, highlights disproportionate resource utilisation and processes such as bed allocation via the site team for older adults. 

Future work for our department will focus on targeted geriatric trauma pathways, exploration of possible bias and earlier multidisciplinary involvement.