Fewer than half of older major trauma patients have a documented treatment escalation plan, national UK audit finds

A one-day national point-prevalence audit across major trauma centres and trauma units in England, Wales and Scotland examined treatment escalation planning and palliative/end-of-life care practice in 957 trauma patients aged 65 and over, across 49 hospitals Audit/Data (Cole & Jarman1). A treatment escalation plan or equivalent was documented in 41.0% of patients (393/957). Among those with a plan, documentation was significantly associated with older age and higher frailty scores; of patients with a plan, only 20.3% were on a documented palliative, time-limited or end-of-life care pathway.

Clinical frailty scoring itself was only recorded in 68.6% of patients, meaning the true rate of unmet palliative or end-of-life need may be undercounted rather than fully captured by this audit.

The authors conclude that greater integration of frailty assessment and earlier goals-of-care discussions are needed for this population; the audit provides a national UK baseline against which any local older-trauma pathway can measure how consistently escalation planning and palliative care triggers are being applied.