Evaluation and management of geriatric trauma: an Eastern Association for the Surgery of Trauma practice management guideline.
The journal of trauma and acute care surgery · 2012-11-01 · Guideline / consensus
Abstract
BACKGROUND: Aging patients constitute an increasing proportion of patients treated at trauma centers. Previous and existing guidelines addressing care of the injured elder have not adequately addressed emerging data regarding optimal means for undertaking triage decisions, correcting coagulopathy, and the limitations of supraphysiologic resuscitation. METHODS: More than 400 MEDLINE citations published between the years 2000 and 2008 were identified and screened. A total of 90 references were selected for the evidentiary table followed by consensus-based discussions regarding the level of evidence and the strength of recommendations that could be derived from the related findings of the individual studies. RESULTS: In general, a lower threshold for trauma activation should be used for injured patients aged 65 years or older who are evaluated at trauma centers. Furthermore, elderly patients with at least one body system with an AIS score of 3 or higher or a base deficit of -6 or less should be treated at trauma centers, preferably in intensive care units staffed by surgeon-intensivists. In addition, all elderly patients who receive daily therapeutic anticoagulation should have appropriate assessment of their coagulation profile and cross-sectional imaging of the brain as soon as possible after admission where appropriate. In patients aged 65 years or older with a Glasgow Coma Scale (GCS) score less than 8, if substantial improvement in GCS is not realized within 72 hours of injury, consideration should be given to limiting further aggressive therapeutic interventions. CONCLUSION: Effective evidence-based care of aging patients necessitates aggressive triage, correction of coagulopathy, and limitation of care when clinical evidence points toward an overwhelming likelihood of poor long-term prognosis.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Oral anticoagulants · Antithrombotics & thrombolytics · Mortality & survival · Older adults
Related articles
- The Dilemma of Prehospital Trauma Triage in Geriatric Anticoagulated Patients Sustaining Falls: Are Objective Clinical Factors Actually Helpful? (Am Surg, 2026)
- The European Perspective on the Management of Acute Major Hemorrhage and Coagulopathy after Trauma: Summary of the 2019 Updated European Guideline. (J Clin Med, 2021)
- Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. (J Trauma Acute Care Surg, 2020)
- The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. (Crit Care, 2016)
- Management of bleeding and coagulopathy following major trauma: an updated European guideline. (Crit Care, 2013)
- Epidemiology of geriatric trauma patients in Norway: A nationwide analysis of Norwegian Trauma Registry data, 2015-2018. A retrospective cohort study. (Injury, 2021)