Regional Geriatric Trauma Advice for Older Patients with Chronic Subdural Haematoma—A Novel Service for Multi-Disciplinary Decision-Making

Background: Chronic subdural haematoma (cSDH) is one of the most common neurocranial conditions in older adults and is increasing in incidence. Conservatively managed patients are typically older, frailer, and more comorbid than surgical candidates, yet specialist geriatrician input into their management is rarely formalised. Potential for geographic inequity in hub-and-spoke neurosurgical networks within the UK compounds this challenge. We describe a service evaluation of a novel regional geriatric trauma advice service providing specialist trauma geriatrician input into cSDH management alongside the neurosurgical team, across a single UK Neurosurgical Network. To the authors’ knowledge, this is the first of its kind in the UK. Prior to this service ‘normal’ care within our region was no routine specialist medical input. Methods: A service evaluation of all referrals received by the North Bristol National Health Service (NHS) Trust geriatric trauma team between July 2024 and March 2026 was performed by the authors. Referrals were discussed within a multidisciplinary team including geriatric trauma, interventional neuroradiology and neurosurgery. Individuals’ demographic data, advice types, management enhancement, intervention outcomes and mortality were recorded and analysed descriptively. Management enhancement was defined as a definitive management decision that resulted in either an action or an active decision not to act. Results: Ninety referrals were included. Median age was 83 years (IQR 77–88) and median Clinical Frailty Scale (CFS) score was 4, with 50% classified as frail (CFS 4–8). Referrals were received from five satellite NHS trusts and the community. Three-quarters (75.6%) required multiple concurrent advice types; Middle Meningeal Artery Embolisation (MMAE) suitability (93.3%) and antithrombotic management (51.1%) were the most frequent. Specialist geriatrician input enhanced management in 97.8% of cases. Forty percent of conservatively managed patients were converted to active intervention, most commonly standalone MMAE (50%). Of district general hospital patient referrals, 40.3% were conveyed to the neurosurgical centre following geriatric trauma review. Mortality was comparatively lower at multiple time points when compared to existing UK data for conservatively managed patients. Conclusions: A regional virtual geriatric trauma advice service for older adults with cSDH is feasible and is associated with enhanced management of this cohort, potentially improving access to treatment. Combining neurosurgical, neurointerventional and geriatrician expertise through a structured multi-disciplinary team (MDT) approach addresses the clinical complexity of this patient group and the potential geographic inequity of hub-and-spoke networks. Further research is needed to investigate the impact of routine geriatrician input into cSDH care.