Department of Emergency Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve St Georges, France.
Department of General Minimally Invasive Surgery, Infermi Hospital, AUSL Romagna, Rimini, Italy.
World J Emerg Surg. 2024 May 31;19(1):18. doi: 10.1186/s13017-024-00537-8.
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.
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，并与虚弱相关。虚弱是老年创伤患者死亡的一个危险因素。我们旨在为老年创伤患者的管理提供循证指南，以改善治疗效果并减少无效操作。
六个专家急性护理和创伤外科工作组根据主题和分配的 PICO 问题广泛审查了文献。根据 GRADE 方法评估陈述和建议，并在 2023 年第 10 届 WSES 国际大会上由该领域的专家共识批准。
老年创伤患者的管理需要了解衰老生理学、进行有针对性的分诊，包括药物史、虚弱评估、营养状况，并尽早启动创伤方案以改善结局。老年急性创伤疼痛需要采用多模式镇痛方法进行管理，以避免阿片类药物使用的副作用。建议在穿透性（腹部、胸部）创伤、严重烧伤和开放性骨折老年患者中预防性使用抗生素，以减少感染性并发症。在没有感染和感染性休克迹象的情况下，不建议在钝性创伤中使用抗生素。根据肾功能、患者体重和出血风险，应尽快在高风险和中风险老年创伤患者中使用低分子肝素或普通肝素进行静脉血栓栓塞预防。应尽快让姑息治疗团队介入，以多学科方式讨论生命末期问题，考虑患者的指示、家属的感受和代表的愿望，所有决策都应共同做出。
老年创伤患者的管理需要了解衰老生理学、基于评估虚弱的有针对性的分诊以及尽早启动创伤方案以改善结局。需要老年重症监护病房来以多学科方式照顾老年和虚弱的创伤患者，以降低死亡率并改善结局。
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