Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Practice Guideline
. 2024 May 31;19(1):18.
doi: 10.1186/s13017-024-00537-8.

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

Belinda De Simone  1   2   3 , Elie Chouillard  4 , Mauro Podda  5 , Nikolaos Pararas  6 , Gustavo de Carvalho Duarte  7 , Paola Fugazzola  8 , Arianna Birindelli  9 , Federico Coccolini  10 , Andrea Polistena  11 , Maria Grazia Sibilla  12 , Vitor Kruger  13 , Gustavo P Fraga  13 , Giulia Montori  14 , Emanuele Russo  15 , Tadeja Pintar  16 , Luca Ansaloni  7 , Nicola Avenia  17 , Salomone Di Saverio  18 , Ari Leppäniemi  19 , Andrea Lauretta  20 , Massimo Sartelli  21 , Alessandro Puzziello  22 , Paolo Carcoforo  12 , Vanni Agnoletti  15 , Luca Bissoni  15 , Arda Isik  23 , Yoram Kluger  24 , Ernest E Moore  25 , Oreste Marco Romeo  26 , Fikri M Abu-Zidan  27 , Solomon Gurmu Beka  28 , Dieter G Weber  29 , Edward C T H Tan  30 , Ciro Paolillo  31 , Yunfeng Cui  32 , Fernando Kim  33 , Edoardo Picetti  34 , Isidoro Di Carlo  35 , Adriana Toro  35 , Gabriele Sganga  36 , Federica Sganga  37 , Mario Testini  38 , Giovanna Di Meo  38 , Andrew W Kirkpatrick  39 , Ingo Marzi  40 , Nicola déAngelis  41 , Michael Denis Kelly  42 , Imtiaz Wani  43 , Boris Sakakushev  44 , Miklosh Bala  45 , Luigi Bonavina  46 , Joseph M Galante  47 , Vishal G Shelat  48 , Lorenzo Cobianchi  8   49 , Francesca Dal Mas  50   49 , Manos Pikoulis  5 , Dimitrios Damaskos  51 , Raul Coimbra  52 , Jugdeep Dhesi  53 , Melissa Red Hoffman  54 , Philip F Stahel  55 , Ronald V Maier  56 , Andrey Litvin  57 , Rifat Latifi  58   59 , Walter L Biffl  60 , Fausto Catena  61
Affiliations
Practice Guideline

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

Belinda De Simone et al. World J Emerg Surg. .

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.

Keywords: Ageing; Antibiotics; Delirium; Direct oral anticoagulants management; Elderly; End of life; Frailty; Geriatric patient; Imaging; Laboratory test; Pain control; Palliative care; Resuscitation; Thrombo-prophylaxis; Trauma management; Trauma score; Vitamin K antagonists anticoagulants management.

PubMed Disclaimer

Conflict of interest statement

All authors are Editorial Board members of World Journal of Emergency Surgery, and were excluded from the peer review process for this article.

Figures

Fig. 1
Fig. 1
The Geriatric Trauma Outcome Score (GTOS)
Fig. 2
Fig. 2
The Trauma-specific Frailty Index (TSFI)
Fig. 3
Fig. 3
Rib fracture analgesia algorithm (Ref. [360])
See this image and copyright information in PMC

References

    1. Halaweish I, Alam HB. Changing demographics of the American population. Surg Clin North Am 2015;95(1):1–10 [Grabo, D. J., B. M. Braslow, and C. W. Schwab. "Current therapy of trauma and surgical critical care." Elsevier (2016) - PubMed
    1. ec.Europa.EU/Eurostat/statistics-explained/index.PHP title=Population_structure_and_ageing
    1. Herd BM, Herd AN, Tanner NS. Burns to the elderly: a reappraisal. Br J Plast Surg. 1987;40(3):278–282. doi: 10.1016/0007-1226(87)90123-8. - DOI - PubMed
    1. Grabo DJ, Braslow BM, Schwab CW. Current therapy of trauma and surgical critical care. In: Asensio JA, Trunkey D, editors. 2nd edition. Elsevier; 2016.
    1. The Department of Health and Human Services, Administration on Ageing. Projected future growth of the older population. Available at: http://www.aoa.gov/ aoaroot/aging_statistics/future_growth/future_growth.aspx#age. Accessed July 20, 2012.

Publication types