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Three Part Question

In [older patients with major trauma] what [early clinical interventions] improve [patient outcomes]

Clinical Scenario

You are expecting an 80 year old major trauma patient into the resuscitation room of the emergency department. You wonder what early interventions might improve her outcomes.

Search Strategy

MEDLINE 1966-05/22, CINAHL 1982-05/22 Via EBSCOhost and AMED 1985-05/22, EMBASE 1974-05/22 via Ovid. In addition, the Cochrane database was searched

Search re-run July 2024 725 papers with 6 of relevance)
EBSCOhost
AB ( Frail OR “older person” OR Geriatric OR Frailty OR silver ) AND AB ( “major trauma” OR “silver trauma” OR Trauma OR polytrauma OR ISS15 ) AND AB ( Intervention OR treatment OR management OR procedure ) AND AB improve AND AB ( Outcome(s) OR Experience OR Mortality OR Morbidity OR survival )

OVID
(Frail or Old or 'older person' or Geriatric or Frailty or silver) and ('major trauma' or 'silver trauma' or Trauma or polytrauma) and (Intervention or treatment or management or procedure) and improve and (Outcome or Experience or Mortality or Morbidity or survival)).ab.

Search Outcome

725 papers with 6 of relevance)

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

There is a paucity of evidence describing effective early interventions affecting mortality in the frail older trauma patient. The evidence that has been found describes early trauma team activation and aggressive monitoring and resuscitation resulting in improved outcomes but these studies are single centre, based in the USA and did not appreciate the low mechanism patients with hidden injuries.

Clinical Bottom Line

While this topic required further research the studies found re-iterate that trauma team activation and aggressive management of identified major trauma improves patient outcomes irrespective of age.

References

1. D. Demetriades, M. Karaiskakis, G. Velmahos, K. Alo, E. Newton, J. Murray, J.Asensio, H.Belzberg, T. Berne and W. Showmaker Effect on outcome of early intensive management of geriatric trauma patients
2. David Bar-Or, Kristin M. Salottolo, Alessandro Orlando, Charles W. Mains, Pamela Bourg and Patrick J. Offner Association Between a Geriatric Trauma Resuscitation Protocol Using Venous Lactate Measurements and Early Trauma Surgeon Involvement and Mortality Risk
3. Bryan W. Carr, Peter M. Hammer, Lava Timsina, Grace Rozycki, David V. Feliciano and Jamie J. Coleman Increased trauma activation is not equally beneficial for all elderly trauma patients
4. Alouidor, R., Siu, M., Roh, S., Perez Coulter, A.M., Kamine, T.H., Kramer, K.Z., Winston, E.S., Ryb, G., Putnam, A.T. and Kelly, E. Impact of Modified Geriatric Trauma Activation Criteria on patient outcomes at a level 1 trauma center. Trauma (United Kingdom), 2024 26(1), pp.7–1
5. Park, C., Bharija, A., Mesias, M., Mitchell, A., Krishna, P., Storr-Street, N., Brown, A., Martin, M., Lu, A.C. and Staudenmayer, K.LPark, C., Bharija, A., Mesias, M., Mitchell, A., Krishna, P., Storr Association between Implementation of a Geriatric Trauma Clinical Pathway and Changes in Rates of Delirium in Older Adults with Traumatic Injury. JAMA Surgery, 157(8), pp.676–683 2022, 157(8), pp.676–683
6. De Simone, B., Chouillard, E., Podda, M et al, The 2023 WSES guidelines on the management of trauma in elderly and frail patients World Journal of Emergency Surgery, [online] 2024, 19(1), pp.1–61. https://doi.org/10.1186/s13017-024-00537-8.