World Journal of Emergency Surgery (May 2024)
The 2023 WSES guidelines on the management of trauma in elderly and frail patients
- Belinda De Simone,
- Elie Chouillard,
- Mauro Podda,
- Nikolaos Pararas,
- Gustavo de Carvalho Duarte,
- Paola Fugazzola,
- Arianna Birindelli,
- Federico Coccolini,
- Andrea Polistena,
- Maria Grazia Sibilla,
- Vitor Kruger,
- Gustavo P. Fraga,
- Giulia Montori,
- Emanuele Russo,
- Tadeja Pintar,
- Luca Ansaloni,
- Nicola Avenia,
- Salomone Di Saverio,
- Ari Leppäniemi,
- Andrea Lauretta,
- Massimo Sartelli,
- Alessandro Puzziello,
- Paolo Carcoforo,
- Vanni Agnoletti,
- Luca Bissoni,
- Arda Isik,
- Yoram Kluger,
- Ernest E. Moore,
- Oreste Marco Romeo,
- Fikri M. Abu-Zidan,
- Solomon Gurmu Beka,
- Dieter G. Weber,
- Edward C. T. H. Tan,
- Ciro Paolillo,
- Yunfeng Cui,
- Fernando Kim,
- Edoardo Picetti,
- Isidoro Di Carlo,
- Adriana Toro,
- Gabriele Sganga,
- Federica Sganga,
- Mario Testini,
- Giovanna Di Meo,
- Andrew W. Kirkpatrick,
- Ingo Marzi,
- Nicola déAngelis,
- Michael Denis Kelly,
- Imtiaz Wani,
- Boris Sakakushev,
- Miklosh Bala,
- Luigi Bonavina,
- Joseph M. Galante,
- Vishal G. Shelat,
- Lorenzo Cobianchi,
- Francesca Dal Mas,
- Manos Pikoulis,
- Dimitrios Damaskos,
- Raul Coimbra,
- Jugdeep Dhesi,
- Melissa Red Hoffman,
- Philip F. Stahel,
- Ronald V. Maier,
- Andrey Litvin,
- Rifat Latifi,
- Walter L. Biffl,
- Fausto Catena
Affiliations
- Belinda De Simone
- Department of Emergency Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges
- Elie Chouillard
- General Surgery Department, American Hospital of Paris
- Mauro Podda
- Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari
- Nikolaos Pararas
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA)
- Gustavo de Carvalho Duarte
- New Zealand Blood Service
- Paola Fugazzola
- Unit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia
- Arianna Birindelli
- Unit of General Surgery, Esine Hospital, ASST Valcamonica
- Federico Coccolini
- Department of General Surgery, University Hospital of Pisa
- Andrea Polistena
- Department of Surgery, Policlinico Umberto I Roma, Sapienza University
- Maria Grazia Sibilla
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara
- Vitor Kruger
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas
- Gustavo P. Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas
- Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital
- Emanuele Russo
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital
- Tadeja Pintar
- UMC Ljubljana and Medical Faculty Ljubljana
- Luca Ansaloni
- New Zealand Blood Service
- Nicola Avenia
- Endocrine Surgical Unit - University of Perugia
- Salomone Di Saverio
- General Surgery Unit, Madonna del Soccorso Hospital, AST Ascoli Piceno
- Ari Leppäniemi
- Division of Emergency Surgery, Helsinki University Hospital and University of Helsinki
- Andrea Lauretta
- Department of Surgical Oncology, Centro Di Riferimento Oncologico Di Aviano IRCCS
- Massimo Sartelli
- Department of General Surgery, Macerata Hospital
- Alessandro Puzziello
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Campus Universitario di Baronissi (SA) - Università di Salerno, AOU San Giovanni di Dio e Ruggi di Aragona
- Paolo Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara
- Vanni Agnoletti
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital
- Luca Bissoni
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital
- Arda Isik
- Istanbul Medeniyet University
- Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus
- Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado
- Oreste Marco Romeo
- Bronson Methodist Hospital/Western Michigan University
- Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University
- Solomon Gurmu Beka
- Ethiopian Air Force Hospital
- Dieter G. Weber
- Department of General Surgery, Royal Perth Hospital and The University of Western Australia
- Edward C. T. H. Tan
- Department of Surgery, Radboud University Medical Center
- Ciro Paolillo
- Emergency Department, Ospedale Civile Maggiore
- Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University
- Fernando Kim
- University of Colorado Anschutz Medical Campus
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital
- Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania
- Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania
- Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University
- Federica Sganga
- Department of Geriatrics, Ospedale Sant’Anna
- Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari “A. Moro”
- Giovanna Di Meo
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari “A. Moro”
- Andrew W. Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre
- Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt
- Nicola déAngelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité
- Michael Denis Kelly
- Department of General Surgery, MedAlliance
- Imtiaz Wani
- Department of Surgery, Government Gousia Hospital, DHS
- Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George
- Miklosh Bala
- Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem
- Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan
- Joseph M. Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis
- Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital
- Lorenzo Cobianchi
- Unit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia
- Francesca Dal Mas
- Department of Management, Ca’ Foscari University of Venice
- Manos Pikoulis
- Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari
- Dimitrios Damaskos
- Department of Surgery, Royal Infirmary of Edinburgh
- Raul Coimbra
- Riverside University Health System Medical Center
- Jugdeep Dhesi
- Guy’s and St Thomas’ NHS Foundation Trust
- Melissa Red Hoffman
- Department of Surgery, University of North Carolina, Surgical Palliative Care Society
- Philip F. Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University
- Ronald V. Maier
- Harborview Medical Center, University of Washington
- Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, University Clinic
- Rifat Latifi
- University of Arizona
- Walter L. Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group
- Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital‐Level 1 Trauma Center, AUSL Romagna
- DOI
- https://doi.org/10.1186/s13017-024-00537-8
- Journal volume & issue
-
Vol. 19,
no. 1
pp. 1 – 61
Abstract
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. Graphical abstract
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