MODET
Research type
Research Study
Full title
Multiple Organ Dysfunction in Elderly Trauma: A pan-London major trauma prospective observational study
IRAS ID
209230
Contact name
Elaine Cole
Contact email
Sponsor organisation
Queen Mary University of London
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Research Summary
For the first time there are 11 and a half million people aged 65 or over in the UK. The number of older people suffering traumatic injuries is increasing. Many patients who initially survive their injuries will develop complications such as multiple organ dysfunction (MODS) whilst in hospital. MODS affects all ages, however younger people seem to recover quickly whilst older patients appear to suffer for longer. MODS keeps older people in hospital for extended periods and increases their risk of dying. After discharge, recovery can be greatly delayed and return to their pre-injury state may be severely diminished as a result of MODS. We don’t know why MODS is worse for older people. It may be associated with increasing age or frailty, or changes in the way the elderly immune system responds to injury. We wish to carry out a research study into MODS in older patients to understand how to improve their quality of recovery in hospital and hopefully benefit longer term rehabilitation after traumatic injury.
Summary of Results
Major trauma causes severe injury through external ‘blunt’ or penetrating force, and is a leading cause of death and disability. As the UK population increases and people are living longer the national demographic of those suffering major trauma is older and more severely injured than ever before. Low-level falls from standing or sitting are usually unremarkable in younger people, but in older people (defined as those aged 65 years or more) may result in severe injury or death. Furthermore, an increasing proportion of older people are remaining active as they age and are therefore at risk of major trauma via road traffic collisions, sports or work incidents, traditionally associated with younger people.
The goal for survivors of major trauma is to restore optimal health and functioning and return them to their pre-injury state. In order to achieve this, the majority of severely injured patients who survive the early phase after trauma will require admission to a critical care unit within a Major Trauma Centre for intensive treatment and monitoring. Older major trauma patients have longer critical care and hospital stays compared to younger counterparts, often complicated by significant adverse events such as Multiple Organ Dysfunction Syndrome (MODS). It is thought that older patients do not have the physiological reserves to compensate for the stress of injury and critical illness but the predictors of MODS in this group of people had not been investigated in the UK.
The Multiple Organ Dysfunction in Elderly Trauma (MODET) study, funded by the Dunhill Medical Trust was conducted in the four Major Trauma Centres (MTC) in London. Patients (or their consultee) were invited to participate after admission to critical care with severe injury. Based on previous critical care admission numbers, MODET aimed to enrol 1346 participants over a two year period, of which one third would be aged 65 years or more, and two thirds would be younger (<65 years) controls.
Findings showed that the severity, pattern and duration of multi-organ dysfunction syndrome (MODS) did not significantly vary between the younger and older cohorts of adult trauma patients, except in the presence of frailty.
Pre-injury frailty was strongly associated with the development of MODS in older patients, with higher rates of MODS related death or inability to be discharged directly to home.
Older adult trauma patients who sustained a traumatic brain injury (TBI) had, on average, a longer period of multiple organ dysfunction compared to younger adult equivalents. This is despite many patients in the older cohort having a less severe TBI (as determined by head abbreviated injury score).
In-hospital deaths were higher in patients who developed MODS irrespective of age, but was almost twice as high for older patients with MODS compared to younger trauma patients. MODS deaths further increased in frail older patients and in patients with TBI.
Intensive care stays and resource use were not significantly increased in the older cohort of patients with MODS compared to their younger counterparts.
For patients in the older cohort who did not develop MODS and were not frail, the majority survived and outcomes were significantly better. For example, half of these patients returned to their usual place of residence.REC name
London - South East Research Ethics Committee
REC reference
16/LO/1720
Date of REC Opinion
26 Oct 2016
REC opinion
Favourable Opinion