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. 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. 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. 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.

中文翻译：

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2023 年 WSES 老年和体弱患者创伤管理指南


与年轻患者相比，老年人的创伤死亡率更高。衰老与多个系统的生理变化有关，并与虚弱有关。虚弱是老年创伤患者死亡的危险因素。我们的目标是为老年创伤患者的管理提供循证指南，以改善它并减少徒劳的程序。由急症护理和创伤外科医生组成的六个工作组根据主题和分配的 PICO 问题广泛审查了文献。声明和建议根据 GRADE 方法进行评估，并在 2023 年第 10 届 WSES 国际大会上获得该领域专家的共识批准。老年创伤患者的管理需要了解衰老生理学，重点分类，包括用药史、虚弱评估、营养状况和创伤方案的早期激活以改善结果。老年人的急性创伤性疼痛必须采用多模式镇痛方法进行管理，以避免使用阿片类药物的副作用。建议对穿透伤（腹部、胸部）创伤、严重烧伤和开放性骨折老年患者进行抗生素预防，以减少脓毒症并发症。在没有脓毒症和脓毒性休克体征的钝挫伤中，不建议使用抗生素。对于高、中危老年创伤患者，应根据患者的肾功能、体重和出血风险，尽快给予 LMWH 或 UFH 静脉血栓栓塞预防。 姑息治疗团队应尽快参与进来，考虑到患者的指示、家庭感受和代表的愿望，以多学科方法讨论生命的终结，并分享所有决定。老年创伤患者的管理需要老年生理学知识，这是一种基于评估虚弱和早期激活创伤方案以改善结果的重点分诊。需要老年重症监护病房以多学科方法照顾老年和体弱的创伤患者，以降低死亡率并改善结果。