Robert Bourke

188The Ageing of Major Trauma

Background: Traditionally major trauma has been viewed as a disease of young men involved in high-energy transfer mechanisms. The aim of this study is to describe the demographics, clinical details and outcome of major trauma presenting to a tertiary urban university hospital in Ireland over a 31-month period. Methods: An urban tertiary referral teaching hospital was one of the first institutions in Ireland to contribute to the Trauma Audit & Research Network (TARN) database and has been doing so since September 2013. A number of parameters are presented including demographics, mechanism of injury, Injury Severity Score (ISS), mortality and length of stay. Results: 1,088 patients were included in our TARN dataset from September 1st 2013 – March 31st 2016. 50.7% (n = 551) were male. The mean age at presentation was 63.5 years (standard deviation (SD) 22.1). 582 patients (53.5%) were ≥65 years, with a strong female preponderance 65.6% (n = 382) in that cohort. The most common mechanism of injury was “fall less than 2 meters” (n = 665, 61.1%). In the over 65 years population, 81.7% (n = 367) suffered a fall less than 2 meters. 65.5% had an ISS of 1–14 and 34.4% scored >15. The median ISS was 9 (range 1–57). The mean length of stay was 21.0 days (SD 33.8). 51 patients (5.9%) died, of whom 39 were over the age of 65. Conclusions: Our trauma database included more patients over the age of 65 years than under, and the predominant mechanism of injury was one of low energy i.e. fall from less than 2 meters. Our data is in keeping with other recent studies from large trauma databases. It highlights the need to tailor our major trauma services to the specific needs of the older people.

078A Study of the Prevalence and Appropriateness of Proton Pump Inhibitor Prescriptions in an Irish Nursing Home Cohort

Background: Proton pump inhibitors (PPIs) are effective treatments for gastrointestinal symptoms and diseases. Evidence suggests PPIs are often prescribed inappropriately. Recent pharmacoepidemiological research has associated PPI use with an increased risk of dementia. A large-scale study of PPI use in nursing homes reported 27% of residents were taking a PPI. 49% of these prescriptions did not have an evidence based indication [1]. Our aim was to investigate the prevalence and appropriateness of PPI prescriptions in an Irish nursing home cohort. Methods: The data for this nested cohort study was collected as part of research into bowel colonisation with clinically significant bacteria in nursing home patients. The patients’ medical record and drug chart were reviewed. Prescriptions for PPIs were recorded with the name, dose and regimen. An indication for the PPI therapy in line with the drugs summary of product characteristics was sought and recorded. Results: 86 nursing home residents were included in the data collection representing 87% of the resident population. The average age was 84 years old. 57% of patients were prescribed a proton pump inhibitor with lansoprazole being the most commonly prescribed. 59% of these did not have an identifiable indication. The most common indications were treatment of peptic ulcer disease (PUD) and gastro-oesophageal reflux disease (35% each). Conclusion: While more than half of the nursing home patients in this study were prescribed a PPI, the majority did not have a recognised indication. A brief assessment of each resident’s requirement for a PPI would enable more accurate PPI prescribing, possibly avoiding unnecessary adverse effects. Reference 1. Rane P et al. Prevalence and predictors of non-evidence based proton pump inhibitor use among elderly nursing home residents in the US. Research in Social and Administrative Pharmacy 2016; 13: 358–363.