Practice Management Guidelines for Geriatric Trauma: The EAST Practice Management Guidelines Work Group

Advanced age is a well-recognized risk factor for adverse outcomes after trauma. A substantial body of literature, much of it cited within this article, demonstrates increased morbidity and mortality in geriatric trauma patients compared with their younger counterparts. Whether this outcome difference is because of the decreased physiologic reserve that accompanies aging, a higher incidence of preexisting medical conditions in the geriatric patient, or other factors yet to be identified remains unclear. It is clear, however, that good outcomes can be achieved in this patient population when appropriately aggressive trauma care is directed toward geriatric patients with survivable injuries. Implicit in the above statement is the need to identify, as soon as possible after injury, those patients who will benefit from aggressive resuscitation, timely injury management, and posttrauma rehabilitation. It is equally important, however, to limit these intensive and expensive treatment modalities to patients whose injuries are not only survivable but also compatible with an acceptable quality of life. Our purpose in developing this guideline was to provide the trauma practitioner with some evidence-based recommendations that could be used to guide decision-making in the care of the geriatric trauma patient. We began this process by first developing a series of questions, the answers to which we hoped could be supported by the existing scientific literature. The initial set of questions were as follows: Is age itself a marker of increased morbidity/mortality? If so, what age should be used? Is age instead a surrogate for increased preexisting conditions (PECs)? If so, which premorbid conditions are particularly predictive of poor outcomes? Should age itself be a criterion for triage from the field directly to a trauma center, regardless of Glasgow Coma Scale (GCS) score, Trauma Score (TS), and so forth? If so, what age should be used? Do trauma centers have better outcomes with geriatric trauma than nontrauma centers? Are there specific injuries, scores (e.g., Injury Severity Score ISS, TS, GCS score), or PEC/age combinations in geriatric trauma patients that are so unlikely to be survivable that a nonaggressive approach from the outset could be justified? What resuscitation end-points should be used for the geriatric trauma Should geriatric trauma patients If so, what specific of should be used? If which geriatric patients benefit from after the literature, it is that evidence-based to of the questions above are not the there are that of the above there is a of as to a specific age criterion for geriatric trauma. in the geriatric trauma is in the as age than or to and of is for increased mortality from trauma age because age is a and not a adverse outcomes with geriatric trauma are to in a with age as to a as a patient a specific there is of a geriatric trauma patient. some patients a age are in patients with injuries, and injuries, as are patients regardless of or injury or patients who not for a of after of it to outcomes patient much of the geriatric trauma is that than the in patient care that have the to recommendations the of outcomes achieved than not be to geriatric trauma patient. the that it was to the and evidence-based recommendations of the questions of within this of geriatric trauma and of geriatric trauma there was these within this guideline with and for this guideline for geriatric trauma. 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