The 2023 WSES guidelines on the management of trauma in elderly and frail patients

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dc.contributor.authorDe Simone, Belinda
dc.contributor.authorChouillard, Elie
dc.contributor.authorPodda, Mauro
dc.contributor.authorPararas, Nikolaos
dc.contributor.authorde Carvalho Duarte, Gustavo
dc.contributor.authorFugazzola, Paola
dc.contributor.authorBirindelli, Arianna
dc.contributor.authorCoccolini, Federico
dc.contributor.authorPolistena, Andrea
dc.contributor.authorSibilla, Maria G.
dc.contributor.authorKruger, Vitor
dc.contributor.authorFraga, Gustavo P.
dc.contributor.authorMontori, Giulia
dc.contributor.authorRusso, Emanuele
dc.contributor.authorPintar, Tadeja
dc.contributor.authorAnsaloni, Luca
dc.contributor.authorAvenia, Nicola
dc.contributor.authorDi Saverio, Salomone
dc.contributor.authorLeppäniemi, Ari
dc.contributor.authorLauretta, Andrea
dc.contributor.authorSartelli, Massimo
dc.contributor.authorPuzziello, Alessandro
dc.contributor.authorCarcoforo, Paolo
dc.contributor.authorAgnoletti, Vanni
dc.contributor.authorBissoni, Luca
dc.contributor.authorIsik, Arda
dc.contributor.authorKluger, Yoram
dc.contributor.authorMoore, Ernest E.
dc.contributor.authorRomeo, Oreste M.
dc.contributor.authorAbu-Zidan, Fikri M.
dc.contributor.authorBeka, Solomon G.
dc.contributor.authorWeber, Dieter G.
dc.contributor.authorTan, Edward C. T. H.
dc.contributor.authorPaolillo, Ciro
dc.contributor.authorCui, Yunfeng
dc.contributor.authorKim, Fernando
dc.contributor.authorPicetti, Edoardo
dc.contributor.authorDi Carlo, Isidoro
dc.contributor.authorToro, Adriana
dc.contributor.authorSganga, Gabriele
dc.contributor.authorSganga, Federica
dc.contributor.authorTestini, Mario
dc.contributor.authorDi Meo, Giovanna
dc.contributor.authorKirkpatrick, Andrew W.
dc.contributor.authorMarzi, Ingo
dc.contributor.authordéAngelis, Nicola
dc.contributor.authorKelly, Michael D.
dc.contributor.authorWani, Imtiaz
dc.contributor.authorSakakushev, Boris
dc.contributor.authorBala, Miklosh
dc.contributor.authorBonavina, Luigi
dc.contributor.authorGalante, Joseph M.
dc.contributor.authorShelat, Vishal G.
dc.contributor.authorCobianchi, Lorenzo
dc.contributor.authorMas, Francesca D.
dc.contributor.authorPikoulis, Manos
dc.contributor.authorDamaskos, Dimitrios
dc.contributor.authorCoimbra, Raul
dc.contributor.authorDhesi, Jugdeep
dc.contributor.authorHoffman, Melissa R.
dc.contributor.authorStahel, Philip F.
dc.contributor.authorMaier, Ronald V.
dc.contributor.authorLitvin, Andrey
dc.contributor.authorLatifi, Rifat
dc.contributor.authorBiffl, Walter L.
dc.contributor.authorCatena, Fausto
dc.date.accessioned2024-06-02T00:05:06Z
dc.date.available2024-06-02T00:05:06Z
dc.date.issued2024-05-31
dc.date.updated2024-06-02T00:05:06Z
dc.description.abstractAbstract 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. Graphical abstract
dc.identifier.citationWorld Journal of Emergency Surgery. 2024 May 31;19(1):18
dc.identifier.urihttps://doi.org/10.1186/s13017-024-00537-8
dc.identifier.urihttps://hdl.handle.net/1880/118896
dc.language.rfc3066en
dc.rights.holderThe Author(s)
dc.titleThe 2023 WSES guidelines on the management of trauma in elderly and frail patients
dc.typeJournal Article
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