Appropriateness for admission may be determined by EM Consultant discretion, when available (0800-2200).
Please use this reference to determine appropriateness for trauma admissions to CDU, in conjunction with EM SpR discussion.
Typically Appropriate Traumatic Conditions
Inappropriate referrals
- Ongoing resuscitation/haemodynamic instability
- O2 Requirement >2L
- Planned/likely operative intervention
- Polytrauma
- Solid organ injury
- High clinical frailty score
- Delerium
- Anticipated LOS >48hrs
- Spinal Fractures (except stable vertebral fractures - see below)
Appropriate Trauma Admissions for CDU
Isolated Low-Risk Rib Fractures
Appropriate if:
- ≤3 unilateral rib fractures
- No flail segment
- No significant pulmonary contusion
- O2 sats stable on room air or minimal support
- No frailty-related high risk of deterioration
- Independent baseline function
Purpose of admission:
- Analgesia Optimisation (PCA, block, multimodal)
- Physiotherapy review
- Morning mobility check
Not appropriate if:
- ≥4 fractures
- Bilateral injury
- Frail elderly
- Increasing O2 requirement
- Significant underlying lung disease
Please reference the Rib Fracture Analgesia guideline when prescribing analgesia
If the patient is reassessed the morning after CDU admission and unlikely to be discharged that day, they should be admitted to CTS or Medicine.
Blunt Trauma Requiring Serial Examination or Observation
Appropriate if:
- Negative imaging
- Low-risk abdominal or thoracic trauma
Purpose of admission:
- For completion of tertiary survey
- Analgesia optimisation
- Re-examination in morning
Patients must have a clear plan for discharge if examination is stable
Mild Traumatic Brain Injury
Appropriate if:
- GCS 14 - 15
- CT brain normal OR minor injury not requiring neurosurgical admission (per neurosurgery)
- No anticoagulation complexity requiring inpatient reversal
- Socially appropriate for discharge next day
- All mild Traumatic Brain Injury must have a Post Traumatic Amnesia assessment by SLT as part of their CDU admission
Purpose of admission:
- Defined period of neuro-observation
- Senior reassessment
- Tertiary survey completion
Not appropriate if:
- Moderate TBI
- Ongoing confusion
- Anticoagulation complexity
- Delirium
Minor Stable Fractures
Appropriate if:
- Isolated upper limb fractures
- Stable lower limb injuries not requiring surgery
- Mobilising safely
- Stable vertebral fractures requiring bracing - confirm with orthopaedics before admitting to CDU
Not Appropriate:
- Pelvic fractures
- High-risk fragility fractures in frail patients
- Patients pending a definitive management plan from Orthopaedics
Special Considerations
Geriatric Trauma
Geriatric Trauma is not appropriate for CDU if any of the following:
- High Clinical Frailty Score (CFS).
- Delerium
- Anticipated difficulty in discharging
- Polytrauma
- Likely LOS >48hrs
Patients are not appropriate for CDU if they require comprehensive geriatric assessment or prolonged rehabilitation planning. These patients should be admitted under the Trauma Geriatrics Service.
Governance
All trauma patients admitted to the CDU should have a review by the In-Patient Trauma Service when available and completion of a tertiary survey before discharge
- CDU trauma patients remain under ED governance until discharge, unless transferred.
- If LOS exceeds 48hrs:
- Mandatory consultant review
- Escalation to In-Patient Trauma Service or appropriate speciality
CDU cannot function as de facto trauma ward
Escalation Pathway
If deterioration or failure to meet discharge criteria→ Immediate CDU Consultant review and In-Patient Trauma Service discussion OR Specialty admission as appropriate.
CDU should not extend stay beyond 48hrs without explicit senior instruction.
Resources / Links
- Acute Pain Service can review and provide regional anaesthesia for Rib Fractures. Referral via iCM
- Head Injury patients should have a Post Traumatic Amnesia (PTA) assessment performed by SLT.
- The Neuro-Rehabilitation Trauma Clinic can follow up traumatic brain injuries and concussion cases. Referral via IPTS or Trauma Co-Ordinator (via switch)