PDF(Pubmed)
Abstract：
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.
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.
摘要：
背景：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相关，并与虚弱相关。虚弱是老年创伤患者死亡的危险因素。我们旨在为老年创伤患者的管理提供循证指南，以改善其并减少徒劳的程序。
方法：六个专家急性护理和创伤外科医师工作组根据主题和指定的PICO问题广泛审查了文献。根据GRADE方法对声明和建议进行了评估，并在2023年WSES第十届国际大会上获得了该领域专家的共识。
结果：老年创伤患者的管理需要了解衰老生理学，集中的分诊，包括药物史,脆弱评估，营养状况,早期启动创伤治疗方案以改善预后。老年人的急性创伤疼痛必须通过多模式镇痛方法来管理，以避免使用阿片类药物的副作用。建议在穿透性（腹部，胸)创伤，严重烧伤和开放性骨折的老年患者减少脓毒症并发症。在没有败血症和脓毒性休克迹象的钝性创伤中不推荐使用抗生素。高危和中危老年创伤患者应根据肾功能情况尽早使用LMWH或UFH预防静脉血栓栓塞，患者体重和出血风险。姑息治疗小组应尽快参与，以考虑患者的指示，以多学科方法讨论生命的终结。家庭感情和代表的欲望，所有的决定都应该分享。
结论：老年创伤患者的管理需要了解衰老生理学，基于评估虚弱和创伤早期激活方案的重点分诊，以改善结局。需要老年重症监护病房以多学科方法护理老年和虚弱的创伤患者，以降低死亡率并改善预后。
方法：六个专家急性护理和创伤外科医师工作组根据主题和指定的PICO问题广泛审查了文献。根据GRADE方法对声明和建议进行了评估，并在2023年WSES第十届国际大会上获得了该领域专家的共识。
结果：老年创伤患者的管理需要了解衰老生理学，集中的分诊，包括药物史,脆弱评估，营养状况,早期启动创伤治疗方案以改善预后。老年人的急性创伤疼痛必须通过多模式镇痛方法来管理，以避免使用阿片类药物的副作用。建议在穿透性（腹部，胸)创伤，严重烧伤和开放性骨折的老年患者减少脓毒症并发症。在没有败血症和脓毒性休克迹象的钝性创伤中不推荐使用抗生素。高危和中危老年创伤患者应根据肾功能情况尽早使用LMWH或UFH预防静脉血栓栓塞，患者体重和出血风险。姑息治疗小组应尽快参与，以考虑患者的指示，以多学科方法讨论生命的终结。家庭感情和代表的欲望，所有的决定都应该分享。
结论：老年创伤患者的管理需要了解衰老生理学，基于评估虚弱和创伤早期激活方案的重点分诊，以改善结局。需要老年重症监护病房以多学科方法护理老年和虚弱的创伤患者，以降低死亡率并改善预后。
