Geriatric Trauma – A Rising Tide. Assessing Patient Safety Challenges in a Vulnerable Population Using Norwegian Trauma Registry Data and Focus Group Interviews: Protocol for a Mixed Methods Study

Abstract

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Many high- and-middle-income countries around the world are experiencing historic demographical changes: People are living longer, birth rates are decreasing, and older people constitute a growing proportion of the population. This contributes to increasing numbers of geriatric trauma patients. Geriatric patients have higher mortality rates after injury than younger patients, and many characteristics of geriatric patients are risk factors for a poor outcome after trauma, such as high age, pre-existing medical conditions, anticoagulant use, frailty and altered physiological response to trauma. While younger patients are more often injured in high-energy trauma, older patients are more often injured in low-energy trauma, e.g. same-level falls, from which they can sustain severe injury. Despite these differences most trauma systems use the same triage tools for all adults, and the elderly are found to have a high risk of undertriage. Due to the inherent risk-factors of a poor outcome and the fact that trauma systems are not sensitive enough to address these challenges, the geriatric trauma patients are vulnerable. These factors suggest that there might be a patient safety risk for geriatric trauma patients built-in to the Norwegian national trauma system. The way health personnel and trauma systems handle geriatric trauma is only partially explored. Our aim is to assess if patient safety challenges exist for Norwegian geriatric trauma patients, to identify risk areas, and to explore differences in trauma care given to young and elderly trauma patients. This knowledge will contribute to the improvement of trauma care given to the most rapidly increasing population segment in developed countries. Inherent trauma system challenges and patient risk factors might not be the only factors contributing to geriatric trauma outcomes. Questions have been raised about whether negative attitudes towards the elderly – ageism – might contribute to their disproportionately negative outcomes. There is a possibility that expectations of poorer outcomes lead to passive, observational roles and low treatment ambitions, which can create a self-fulfilling prophecy of bad outcomes. This dilemma will be addressed in this project. Objective: The aim of this project is to investigate whether patient safety challenges exist for older trauma patients in Norway. An important objective of the study is to identify risk areas that will facilitate further work to safeguard and promote quality and safety in the Norwegian trauma system. Methods: This is planned as a PhD-project divided into four parts: Three registry-based studies and one qualitative focus group study. By supplementing registry data from the Norwegian Trauma Registry (NTR) with focus group interviews with personnel in the emergency chain we will provide new knowledge about the treatment of geriatric trauma patients, knowledge that due to international trauma system similarities might be transferrable to international trauma systems. Results: The project has received funding from January 2019 through December 2021, and it is approved by the Data Protection Officer responsible for the Norwegian Trauma Registry. An application for access to registry data has been submitted and is pending. Results will be ready for publication from spring 2020. Conclusions: This project is the first step toward increased knowledge about trauma in Norwegian geriatric patients on a national level and will form the basis for further research aiming at interventions that eventually will make the trauma system better equipped to meet the rising tide of geriatric trauma.