Evidence map›Paper›PMID 38816766›Full record

GuidelineWorld journal of emergency surgery : WJES2024

The 2023 WSES guidelines on the management of trauma in elderly and frail patients.

Belinda De Simone, Elie Chouillard, Mauro Podda, Nikolaos Pararas, Gustavo de Carvalho Duarte, Paola Fugazzola, Arianna Birindelli, Federico Coccolini, Andrea Polistena, Maria Grazia Sibilla and 56 more

Abstract readPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in World journal of emergency surgery : WJES, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Article
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  6. Thoracic injuries in elderly trauma patients epidemiology, injury characteristics, in-hospital care and outcome.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026
    Article
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  9. Review
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  15. Influence of frailty on short-term mortality in older patients with multiple trauma in the emergency department.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
    Observational
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  17. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

66 authors.

Belinda De SimoneDepartment of Emergency Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve St Georges, France. desimone.belinda@gmail.com.
Elie ChouillardGeneral Surgery Department, American Hospital of Paris, Paris, France.
Mauro PoddaDepartment of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy.
Nikolaos Pararas3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
Gustavo de Carvalho DuarteNew Zealand Blood Service, Christchurch, New Zealand.
Paola FugazzolaUnit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia, Pavia, Italy.
Arianna BirindelliUnit of General Surgery, Esine Hospital, ASST Valcamonica, Esine, Italy.
Federico CoccoliniDepartment of General Surgery, University Hospital of Pisa, Pisa, Italy.
Andrea PolistenaDepartment of Surgery, Policlinico Umberto I Roma, Sapienza University, Rome, Italy.
Maria Grazia SibillaDepartment of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy.
Vitor KrugerDivision of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Gustavo P FragaDivision of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil.
Giulia MontoriUnit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy.
Emanuele RussoDepartment of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy.
Tadeja PintarUMC Ljubljana and Medical Faculty Ljubljana, Ljubljana, Slovenia.
Luca AnsaloniNew Zealand Blood Service, Christchurch, New Zealand.
Nicola AveniaEndocrine Surgical Unit - University of Perugia, Terni, Italy.
Salomone Di SaverioGeneral Surgery Unit, Madonna del Soccorso Hospital, AST Ascoli Piceno, San Benedetto del Tronto, Italy.
Ari LeppäniemiDivision of Emergency Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Andrea LaurettaDepartment of Surgical Oncology, Centro Di Riferimento Oncologico Di Aviano IRCCS, Aviano, Italy.
Massimo SartelliDepartment of General Surgery, Macerata Hospital, Macerata, Italy.
Alessandro PuzzielloDipartimento di Medicina, Chirurgia e Odontoiatria, Campus Universitario di Baronissi (SA) - Università di Salerno, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy.
Paolo CarcoforoDepartment of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy.
Vanni AgnolettiDepartment of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy.
Luca BissoniDepartment of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy.
Arda IsikIstanbul Medeniyet University, Istanbul, Turkey.
Yoram KlugerDepartment of General Surgery, Rambam Health Care Campus, Haifa, Israel.
Ernest E MooreErnest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA.
Oreste Marco RomeoBronson Methodist Hospital/Western Michigan University, Kalamazoo, MI, USA.
Fikri M Abu-ZidanDepartment of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates.
Solomon Gurmu BekaEthiopian Air Force Hospital, Bishoftu, Oromia, Ethiopia.
Dieter G WeberDepartment of General Surgery, Royal Perth Hospital and The University of Western Australia, Perth, Australia.
Edward C T H TanDepartment of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Ciro PaolilloEmergency Department, Ospedale Civile Maggiore, Verona, Italy.
Yunfeng CuiDepartment of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.
Fernando KimUniversity of Colorado Anschutz Medical Campus, Denver, CO, 80246, USA.
Edoardo PicettiDepartment of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
Isidoro Di CarloDepartment of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy.
Adriana ToroDepartment of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy.
Gabriele SgangaFondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy.
Federica SgangaDepartment of Geriatrics, Ospedale Sant'Anna, Ferrara, Italy.
Mario TestiniDepartment of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy.
Giovanna Di MeoDepartment of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy.
Andrew W KirkpatrickDepartments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada.
Ingo MarziDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany.
Nicola déAngelisUnit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France.
Michael Denis KellyDepartment of General Surgery, MedAlliance, Albury, NSW, Australia.
Imtiaz WaniDepartment of Surgery, Government Gousia Hospital, DHS, Srinagar, India.
Boris SakakushevGeneral Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria.
Miklosh BalaHadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Luigi BonavinaDivision of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
Joseph M GalanteDivision of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA.
Vishal G ShelatDepartment of General Surgery, Tan Tock Seng Hospital, Novena, Singapore.
Lorenzo CobianchiUnit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia, Pavia, Italy.
Francesca Dal MasDepartment of Management, Ca' Foscari University of Venice, Venice, Italy.
Manos PikoulisDepartment of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy.
Dimitrios DamaskosDepartment of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
Raul CoimbraRiverside University Health System Medical Center, Riverside, CA, USA.
Jugdeep DhesiGuy's and St Thomas' NHS Foundation Trust, London, UK.
Melissa Red HoffmanDepartment of Surgery, University of North Carolina, Surgical Palliative Care Society, Asheville, NC, USA.
Philip F StahelDepartment of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
Ronald V MaierHarborview Medical Center, University of Washington, Seattle, WA, USA.
Andrey LitvinDepartment of Surgical Diseases No. 3, Gomel State Medical University, University Clinic, Gomel, Belarus.
Rifat LatifiUniversity of Arizona, Tucson, AZ, USA.
Walter L BifflDivision of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.
Fausto CatenaDepartment of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, AUSL Romagna, Cesena, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe 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.

methodsSix 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.

resultsThe 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.

conclusionsThe 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.

Indexed as

Frail ElderlyWounds and InjuriesAgedAged, 80 and overFrailtyGeriatric AssessmentHumansAgeingAntibioticsDeliriumDirect oral anticoagulants managementElderlyEnd of lifeFrailtyGeriatric patientImagingLaboratory testPain controlPalliative careResuscitationThrombo-prophylaxisTrauma managementTrauma scoreVitamin K antagonists anticoagulants management

Identifiers

PMID38816766
PMCPMC11140935

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.