@article{ref1,
title="The 2023 WSES guidelines on the management of trauma in elderly and frail patients",
journal="World journal of emergency surgery",
year="2024",
author="Bonavina, Luigi and Bala, Miklosh and Kirkpatrick, Andrew W. and Di Meo, Giovanna and Testini, Mario and Sganga, Federica and Sganga, Gabriele and Toro, Adriana and Di Carlo, Isidoro and Picetti, Edoardo and Kim, Fernando and Cui, Yunfeng and Paolillo, Ciro and Tan, Edward C. T. H. and Weber, Dieter G. and Beka, Solomon Gurmu and Abu-Zidan, Fikri M. and Romeo, Oreste Marco and Pararas, Nikolaos and Podda, Mauro and Chouillard, Elie and De Simone, Belinda and Coccolini, Federico and Moore, Ernest E. and Kluger, Yoram and Isik, Arda and Bissoni, Luca and Agnoletti, Vanni and Litvin, Andrey and Maier, Ronald V. and DeAngelis, Nicola and Marzi, Ingo and Sakakushev, Boris and Wani, Imtiaz and Kelly, Michael Denis and Kruger, Vitor and Sibilla, Maria Grazia and Sartelli, Massimo and Polistena, Andrea and Carcoforo, Paolo and Puzziello, Alessandro and Birindelli, Arianna and Fugazzola, Paola and de Carvalho Duarte, Gustavo and Catena, Fausto and Biffl, Walter L. and Latifi, Rifat and Lauretta, Andrea and Leppaniemi, Ari and Di Saverio, Salomone and Avenia, Nicola and Ansaloni, Luca and Pintar, Tadeja and Russo, Emanuele and Montori, Giulia and Fraga, Gustavo P. and Stahel, Philip F. and Hoffman, Melissa Red and Dhesi, Jugdeep and Coimbra, Raul and Damaskos, Dimitrios and Pikoulis, Manos and Mas, Francesca Dal and Cobianchi, Lorenzo and Shelat, Vishal G. and Galante, Joseph M.",
volume="19",
number="1",
pages="e18-e18",
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. <br><br>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. <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="1749-7922",
doi="10.1186/s13017-024-00537-8",
url="http://dx.doi.org/10.1186/s13017-024-00537-8"
}