Evaluation and management of geriatric trauma: An eastern association for the surgery of trauma practice management guideline

James Forrest Calland, Angela M. Ingraham, Niels Martin, Gary T. Marshall, Carl I Schulman, Tristan Stapleton, Robert D. Barraco

Research output: Contribution to journalArticle

108 Citations (Scopus)

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.

Original languageEnglish
JournalJournal of Trauma and Acute Care Surgery
Volume73
Issue number5 SUPPL.4
DOIs
StatePublished - Nov 1 2012

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Practice Management
Practice Guidelines
Geriatrics
Trauma Centers
Wounds and Injuries
Glasgow Coma Scale
Triage
Neuroimaging
Resuscitation
MEDLINE
Intensive Care Units
Patient Care
Guidelines
Therapeutics

Keywords

  • coagulopathy
  • elderly
  • Geriatric
  • guideline
  • triage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Evaluation and management of geriatric trauma : An eastern association for the surgery of trauma practice management guideline. / Calland, James Forrest; Ingraham, Angela M.; Martin, Niels; Marshall, Gary T.; Schulman, Carl I; Stapleton, Tristan; Barraco, Robert D.

In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 5 SUPPL.4, 01.11.2012.

Research output: Contribution to journalArticle

Calland, James Forrest ; Ingraham, Angela M. ; Martin, Niels ; Marshall, Gary T. ; Schulman, Carl I ; Stapleton, Tristan ; Barraco, Robert D. / Evaluation and management of geriatric trauma : An eastern association for the surgery of trauma practice management guideline. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 5 SUPPL.4.
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