e-Article
The 2023 WSES guidelines on the management of trauma in elderly and frail patients.
Document Type
Academic Journal
Author
De Simone B; Department of Emergency Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve St Georges, France. desimone.belinda@gmail.com.; Department of General Minimally Invasive Surgery, Infermi Hospital, AUSL Romagna, Rimini, Italy. desimone.belinda@gmail.com.; General Surgery Department, American Hospital of Paris, Paris, France. desimone.belinda@gmail.com.; Chouillard E; General Surgery Department, American Hospital of Paris, Paris, France.; Podda M; Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy.; Pararas N; 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece.; de Carvalho Duarte G; New Zealand Blood Service, Christchurch, New Zealand.; Fugazzola P; Unit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia, Pavia, Italy.; Birindelli A; Unit of General Surgery, Esine Hospital, ASST Valcamonica, Esine, Italy.; Coccolini F; Department of General Surgery, University Hospital of Pisa, Pisa, Italy.; Polistena A; Department of Surgery, Policlinico Umberto I Roma, Sapienza University, Rome, Italy.; Sibilla MG; Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy.; Kruger V; Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil.; Fraga GP; Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil.; Montori G; Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy.; Russo E; Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy.; Pintar T; UMC Ljubljana and Medical Faculty Ljubljana, Ljubljana, Slovenia.; Ansaloni L; New Zealand Blood Service, Christchurch, New Zealand.; Avenia N; Endocrine Surgical Unit - University of Perugia, Terni, Italy.; Di Saverio S; General Surgery Unit, Madonna del Soccorso Hospital, AST Ascoli Piceno, San Benedetto del Tronto, Italy.; Leppäniemi A; Division of Emergency Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.; Lauretta A; Department of Surgical Oncology, Centro Di Riferimento Oncologico Di Aviano IRCCS, Aviano, Italy.; Sartelli M; Department of General Surgery, Macerata Hospital, Macerata, Italy.; Puzziello A; Dipartimento di Medicina, Chirurgia e Odontoiatria, Campus Universitario di Baronissi (SA) - Università di Salerno, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy.; Carcoforo P; Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy.; Agnoletti V; Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy.; Bissoni L; Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy.; Isik A; Istanbul Medeniyet University, Istanbul, Turkey.; Kluger Y; Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.; Moore EE; Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA.; Romeo OM; Bronson Methodist Hospital/Western Michigan University, Kalamazoo, MI, USA.; Abu-Zidan FM; Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates.; Beka SG; Ethiopian Air Force Hospital, Bishoftu, Oromia, Ethiopia.; Weber DG; Department of General Surgery, Royal Perth Hospital and The University of Western Australia, Perth, Australia.; Tan ECTH; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.; Paolillo C; Emergency Department, Ospedale Civile Maggiore, Verona, Italy.; Cui Y; Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.; Kim F; University of Colorado Anschutz Medical Campus, Denver, CO, 80246, USA.; Picetti E; Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.; Di Carlo I; Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy.; Toro A; Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy.; Sganga G; Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy.; Sganga F; Department of Geriatrics, Ospedale Sant'Anna, Ferrara, Italy.; Testini M; Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari 'A. Moro', Bari, Italy.; Di Meo G; Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari 'A. Moro', Bari, Italy.; Kirkpatrick AW; Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada.; Marzi I; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany.; déAngelis N; Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France.; Kelly MD; Department of General Surgery, MedAlliance, Albury, NSW, Australia.; Wani I; Department of Surgery, Government Gousia Hospital, DHS, Srinagar, India.; Sakakushev B; General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria.; Bala M; Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.; Bonavina L; Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.; Galante JM; Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA.; Shelat VG; Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore.; Cobianchi L; Unit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia, Pavia, Italy.; Collegium Medicum, University of Social Sciences, Łodz, Poland.; Mas FD; Department of Management, Ca' Foscari University of Venice, Venice, Italy.; Collegium Medicum, University of Social Sciences, Łodz, Poland.; Pikoulis M; Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy.; Damaskos D; Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.; Coimbra R; Riverside University Health System Medical Center, Riverside, CA, USA.; Dhesi J; Guy's and St Thomas' NHS Foundation Trust, London, UK.; Hoffman MR; Department of Surgery, University of North Carolina, Surgical Palliative Care Society, Asheville, NC, USA.; Stahel PF; Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.; Maier RV; Harborview Medical Center, University of Washington, Seattle, WA, USA.; Litvin A; Department of Surgical Diseases No. 3, Gomel State Medical University, University Clinic, Gomel, Belarus.; Latifi R; University of Arizona, Tucson, AZ, USA.; Abrazo Health West Campus, Goodyear, Tucson, AZ, USA.; Biffl WL; Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.; Catena F; Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, AUSL Romagna, Cesena, Italy.
Source
Publisher: BioMed Central Country of Publication: England NLM ID: 101266603 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-7922 (Electronic) Linking ISSN: 17497922 NLM ISO Abbreviation: World J Emerg Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures.
Methods: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023.
Results: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient's directives, family feelings and representatives' desires, and all decisions should be shared.
Conclusions: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.
(© 2024. The Author(s).)
Methods: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023.
Results: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient's directives, family feelings and representatives' desires, and all decisions should be shared.
Conclusions: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.
(© 2024. The Author(s).)