Palliative and end of life care in older major trauma – A point prevalence evaluation in England, Wales and Scotland

Published Date: 14th April 2026

Publication Authors: Bannister. J, Coles. H

Introduction
Traumatic injury in older people is a significant health burden with higher mortality rates than younger cohorts. Survival following older trauma may be complicated by the patients pre-injury state and clinical uncertainty. Timely identification of palliative and end-of-life care needs may be challenging for acute clinical teams, and treatment escalation planning is not routinely embedded in trauma care. This point prevalence snap-shot aimed to evaluate treatment escalation discussions and palliative/end of life care (EoLC) practice in older major trauma patients at a national level.

Methods
A one-day point prevalence “flash-mob” audit was conducted across Major Trauma Centres (MTCs) and Trauma Units (TUs) in England, Wales and Scotland. All trauma patients aged ≥ 65 years in hospital were eligible for inclusion. Patients with and without treatment escalation plans (TEPs) and those on care pathways were analysed.

Results
Data from 957 patients in 49 hospitals were included and median time from injury was 11 days (interquartile range 4–24). A TEP or equivalent was documented in 393 patients (41.0%). Among patients with a TEP, there were more aged > 85 years (165/393 (41.9%), than in those without a TEP (167/564 (29.6%), p < 0.001). Clinical frailty scoring was performed in 657 patients (68.6%), and where recorded, TEPs were associated with increased frailty (CFS ≥5 TEP: 68% [207/304] vs. No TEP: 46.4% [164/353], p < 0.001). Polytrauma predominated over any single site injury (TEP: 140/393, 35.6% vs. No TEP: 197/564, 34.9%). Admitting specialty teams differed between groups and those with a TEP were more likely to be under the care of a medical consultant (92/393, 23.4%) compared to only 60/564, 10.6% of the no-TEP patients (p < 0.001). A fifth of those with a TEP were on a documented palliative, time-limited or end-of-life care pathway (20.3%). Care pathways were more likely in those with older age (p < 0.001) and severe frailty (CFS≥7) (p = 0.03) rather than injury type, clinical specialty or advance care plans.

Conclusion
This national snapshot demonstrates limited and variable use of treatment escalation planning with low rates of recorded palliative and EoLC need discussions in older major trauma patients. Greater integration of frailty assessment and early goals-of-care discussions are required to improve care for this growing population.

Cole, E; Jarman, H (Collaborators: Bannister, J; Coles, H et al). (2026). Palliative and end of life care in older major trauma – A point prevalence evaluation in England, Wales and Scotland. Injury. Pub online 14 Apr(.), p.113199. [Online]. Available at: https://doi.org/10.1016/j.injury.2026.113199 [Accessed 1 May 2026]