title: Evaluation and management of geriatric trauma: an Eastern Association for the Surgery of Trauma practice management guideline.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA. calland@virginia.edu
authors.forename: James Forrest
authors.initials: JF
authors.lastname: Calland
authors.forename: Angela M
authors.initials: AM
authors.lastname: Ingraham
authors.forename: Niels
authors.initials: N
authors.lastname: Martin
authors.forename: Gary T
authors.initials: GT
authors.lastname: Marshall
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.forename: Tristan
authors.initials: T
authors.lastname: Stapleton
authors.forename: Robert D
authors.initials: RD
authors.lastname: Barraco
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001778:Blood Coagulation Disorders / Q000139:chemically induced / Q000628:therapy; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D012151:Resuscitation / Q000379:methods / Q000592:standards; D014193:Trauma Centers / Q000592:standards; D014218:Triage / Q000592:standards; D028761:Withholding Treatment / Q000592:standards; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000628:therapy*