Re-issuing the silver trauma screening tool

We are taking the opportunity to re-circulate our silver trauma screening tool (in the downloads below). The idea of the tool is to help us identify potential risk factors/indicators for occult trauma in patients >65. Identifying these risk factors will allow us to further enhance the excellent care you all already provide daily.

The tool has been in operation since Jan 2022, and is being used successfully across the Trust. We do continue to occasionally see incidents where there may have been a missed opportunity to identify risk factors, based on the evidence we have that major trauma in those >65 may not be immediately apparent, and/or not sustained in a high energy mechanism. Therefore, we are taking the opportunity to re-share the unchanged tool, hoping to increase awareness and application of the tool.

Occult injuries are more likely to be present in patients over the age of 65, as reported in the TARN 2017 publication - Major Trauma In Older People, which highlighted that pre-hospital triage is less reliable in this patient group (TARN - Major Trauma In Older People - 2017 Report).

Underestimation of injury load in the pre-hospital setting can result in several downstream impacts to patient care, including longer time to CT and more junior care provision, as well as potential for delayed intervention. 

There is no change to the triage decision making process or the requirement to pre-alert. The silver trauma screening tool has been designed to assist us all with identification of risk factors. Trauma triage decisions should still be made using the existing EoE Trauma Triage Tool. The purpose of identifying risk factors is that we are then able to record these in the patient care record, as well as hand them over to the receiving Emergency Department. 

Please also ensure a high index of suspicion for significant trauma being sustained in mechanisms such as fall from standing in this patient group. We should always consider spinal injuries in this patient group and use Canadian C-Spine rule to support decision making (Recommendations | Spinal injury: assessment and initial management | Guidance | NICE). It is also important for us to ensure adequate analgesia is offered (or refusal thereof) and documented in the patient care record, as our data suggests this patient group are at risk of under analgesia in the pre-hospital phase.

The tool is currently embedded in the ePCR software as a PDF, as further development we are also looking to include the screening tool as a field to complete within the ePCR.

The other attachment is an ATMISTER pre-alert aide memoir. This format should be applied to all trauma pre-alert calls and subsequent handovers and is also suitable to utilise for all other patient groups.

If you have any feedback on either tool or any other aspects of trauma care, please get in touch with Rob.Riches@eastamb.nhs.uk

Published 5th October 2023