Silver Trauma Assessments - What Do We Miss ?

Introduction

Data from the Trauma Audit & Research Network (TARN) show that older adults now represent the majority of trauma admissions with frailty associated with an increased 30-day mortality. TARN highlights inequalities in care for patients aged >60 years, including delayed surgery and reduced senior input. This quality improvement project assessed whether older trauma patients receive a structured and thorough Emergency Department (ED) assessment in line with the HECTOR pro forma.

Method

A retrospective review of patients aged >65 years (n=50) presenting to Huddersfield Royal Infirmary with neck of femur (NOF) fracture between January 2024 and January 2025 was conducted. Demographics along with documentation of primary survey, secondary survey and anticoagulation status were analysed against HECTOR standards.

An intervention comprising of targeted “silver trauma” teaching sessions, documentation prompts and aide-mémoires for ED clinicians was delivered. A second retrospective cycle (n=12) between June and August 2025 evaluated impact.

Results

Of 50 patients, 16% (n=8) had dementia; 72% (n=36) were female. All had mechanism of injury documented (n=50), but only 34% (n=17) had a complete primary survey recorded. Anticoagulation status was documented in 58% (n=29).

Secondary survey documentation was limited: upper limbs (6% n=3), chest (20% n=10), abdomen (16% n=8), and lower limbs (6% n=3).

Post-intervention, anticoagulation documentation decreased (58% to 25%). Head examination documentation improved (0% to 17%) and lower limb documentation increased (6% to 42%), though other domains showed minimal or no improvement. Small sample size limited statistical interpretation.

Conclusion

Teaching alone did not meaningfully improve structured trauma assessment documentation. Barriers likely include clinician experience, ED workload pressures and perceived responsibility of orthopaedics for further assessment. Sustainable improvement may require system-level changes, including embedded pro formas, structured e-learning and integration into departmental induction.