Advertisement
Review Article| Volume 41, ISSUE 1, P183-203, February 2023

Trauma in the Aging Population

Geriatric Trauma Pearls

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Emergency Medicine Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hill A.D.
        • Pinto R.
        • Nathens A.B.
        • et al.
        Age-related trends in severe injury hospitalization in Canada.
        J Trauma Acute Care Surg. 2014; 77: 608-613
        • Cioffi W.G.
        • Connolly M.D.
        • Adams C.A.
        • et al.
        The National Trauma Data Bank Annual Report.
        Encycl Intensive Care Med. 2012; : 2206
        • Clark D.
        • Fantus R.
        National Trauma Data Bank Annual Report 2007.
        Am Coll Surg. 2007;
        • Kehoe A.
        • Smith J.E.
        • Edwards A.
        • et al.
        The changing face of major trauma in the UK.
        Emerg Med J. 2015; 32: 911-915
        • Kojima M.
        • Endo A.
        • Shiraishi A.
        • et al.
        Age-related characteristics and outcomes for patients with severe trauma: analysis of Japan’s Nationwide Trauma Registry.
        Ann Emerg Med. 2019; 73: 281-290
        • Caterino J.M.
        • Valasek T.
        • Werman H.A.
        Identification of an age cutoff for increased mortality in patients with elderly trauma.
        Am J Emerg Med. 2010; 28: 151-158
        • Goodmanson N.W.
        • Rosengart M.R.
        • Barnato A.E.
        • et al.
        Defining geriatric trauma: when does age make a difference?.
        Surg (United States). 2012; 152: 668-675
        • Lundebjerg N.E.
        • Trucil D.E.
        • Hammond E.C.
        • et al.
        When it comes to older adults, language matters: Journal of the American Geriatrics Society Adopts Modified American Medical Association Style.
        J Am Geriatr Soc. 2017; 65: 1386-1388
        • Sammy I.
        • Lecky F.
        • Sutton A.
        • et al.
        Factors affecting mortality in older trauma patients: a systematic review and meta-analysis.
        Injury. 2016; 47: 1170-1183
        • Savioli G.
        • Ceresa I.F.
        • Macedonio S.
        • et al.
        Major trauma in elderly patients: worse mortality and outcomes in an Italian trauma center.
        J Emerg Trauma Shock. 2021; 14: 98-103
        • Perdue P.W.
        • Watts D.D.
        • Kaufmann C.R.
        • et al.
        Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death.
        J Trauma. 1998; 45: 805-810
        • Aitken L.M.
        • Burmeister E.
        • Lang J.
        • et al.
        Characteristics and outcomes of injured older adults after hospital admission.
        J Am Geriatr Soc. 2010; 58: 442-449
        • Konda S.R.
        • Lott A.
        • Mandel J.
        • et al.
        Who is the geriatric trauma patient? An analysis of patient characteristics, hospital quality measures, and inpatient cost.
        Geriatr Orthop Surg Rehabil. 2020; 11: 1-8
        • Labib N.
        • Nouh T.
        • Winocour S.
        • et al.
        Severely injured geriatric population: morbidity, mortality, and risk factors.
        J Trauma. 2011; 71: 1908-1914
        • Ganz D.A.
        • Bao Y.
        • Shekelle P.G.
        • et al.
        Will my patient fall?.
        JAMA. 2007; 297: 77-86
        • Kwan E.
        • Straus S.E.
        • Kwan E.
        Mayores 2. 2014; 186
        • Newgard C.D.
        • Fischer P.E.
        • Gestring M.
        • et al.
        National guideline for the field triage of injured patients: recommendations of the national expert panel on field triage, 2021.
        J Trauma Acute Care Surg. 2022; https://doi.org/10.1097/ta.0000000000003627
        • Heffernan D.S.
        • Thakkar R.K.
        • Monaghan S.F.
        • et al.
        Normal presenting vital signs are unreliable in geriatric blunt trauma victims.
        J Trauma. 2010; 69: 813-820
        • Martin J.T.
        • Alkhoury F.
        • O’Connor J.A.
        • et al.
        Normal” vital signs belie occult hypoperfusion in geriatric trauma patients.
        Am Surg. 2010; 76: 65-69
        • Demetriades D.
        • Sava J.
        • Alo K.
        • et al.
        Old age as a criterion for trauma team activation.
        J Trauma. 2001; 51 ([discussion: 756–7]): 754-756
        • Brown J.B.
        • Gestring M.L.
        • Forsythe R.M.
        • et al.
        Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma: 110 is the new 90.
        J Trauma Acute Care Surg. 2015; 78: 352-359
        • Mutschler M.
        • Nienaber U.
        • Münzberg M.
        • et al.
        The Shock Index revisited: a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the TraumaRegister DGU.
        Crit Care. 2013; 17: R172
        • Zarzaur B.L.
        • Croce M.A.
        • Fischer P.E.
        • et al.
        New vitals after injury: shock index for the young and age x shock index for the old.
        J Surg Res. 2008; 147: 229-236
        • Navaratnarajah A.
        • Jackson S.H.D.
        The physiology of ageing.
        Medicine (Baltimore). 2013; 41: 5-8
        • Aalami O.O.
        • Fang T.D.
        • Song H.M.
        • et al.
        Physiological features of aging persons.
        Arch Surg. 2003; 138: 1068-1076
        • Rockwood K.
        A global clinical measure of fitness and frailty in elderly people.
        Can Med Assoc J. 2005; 173: 489-495
        • Faller J.W.
        • Pereira D. do N.
        • de Souza S.
        • et al.
        Instruments for the detection of frailty syndrome in older adults: a systematic review.
        PLoS One. 2019; 14: e0216166
        • Cheung A.
        • Haas B.
        • Ringer T.J.
        • et al.
        Canadian Study of Health and Aging Clinical Frailty Scale: does it predict adverse outcomes among geriatric trauma patients?.
        J Am Coll Surg. 2017; 225: 658-665.e3
        • Joseph B.
        • Orouji Jokar T.
        • Hassan A.
        • et al.
        Redefining the association between old age and poor outcomes after trauma: the impact of frailty syndrome.
        J Trauma Acute Care Surg. 2017; 82: 575-581
        • Joseph B.
        • Pandit V.
        • Zangbar B.
        • et al.
        Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis.
        JAMA Surg. 2014; 149: 766-772
        • Poulton A.
        • Shaw J.F.
        • Nguyen F.
        • et al.
        The association of frailty with adverse outcomes after multisystem trauma: a systematic review and meta-analysis.
        Anesth Analg. 2020; 130: 1482-1492
        • Haas B.
        • Wunsch H.
        How does prior health status (age, comorbidities and frailty) determine critical illness and outcome?.
        Curr Opin Crit Care. 2016; 22: 500-505
        • Cubitt M.
        • Downie E.
        • Shakerian R.
        • et al.
        Timing and methods of frailty assessments in geriatric trauma patients: a systematic review.
        Injury. 2019; 50: 1795-1808
        • ACS Committee on Trauma
        ACS TQIP Geriatric Trauma Management Guidelines.
        Am Coll Surg. 2013; (Available at:): 1-31
        • Alshibani A.
        • Alharbi M.
        • Conroy S.
        Under-triage of older trauma patients in prehospital care: a systematic review.
        Eur Geriatr Med. 2021; 12: 903-919
        • Chang D.C.
        • Bass R.R.
        • Cornwell E.E.
        • et al.
        Undertriage of elderly trauma patients to state-designated trauma centers.
        Arch Surg. 2008; 143 ([discussion: 782]): 776-781
        • Nordgarden T.
        • Odland P.
        • Guttormsen A.B.
        • et al.
        Undertriage of major trauma patients at a university hospital: a retrospective cohort study.
        Scand J Trauma Resusc Emerg Med. 2018; 26: 64
        • Anantha R.V.
        • Painter M.D.
        • Diaz-Garelli F.
        • et al.
        undertriage despite use of geriatric-specific trauma team activation guidelines : who are we missing?.
        Am Surg. 2021; 87: 419-426
        • Xiang H.
        • Wheeler K.K.
        • Groner J.I.
        • et al.
        Undertriage of major trauma patients in the US emergency departments.
        Am J Emerg Med. 2014; 32: 997-1004
        • Ichwan B.
        • Darbha S.
        • Shah M.N.
        • et al.
        Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults.
        Ann Emerg Med. 2015; 65: 92-100.e3
      1. Field Trauma Triage and Air Ambulance Utilization Standards. Emergency Health Services Branch, Ministry of Health and Long-Term Care.
        • Barraco R.
        • Chiu W.
        • Bard M.
        • et al.
        Practice management guidelines for the appropriate triage of the victim of trauma.
        (Available at:)
        • Boulton A.J.
        • Peel D.
        • Rahman U.
        • et al.
        Evaluation of elderly specific pre-hospital trauma triage criteria: a systematic review.
        Scand J Trauma Resusc Emerg Med. 2021; 29https://doi.org/10.1186/s13049-021-00940-z
        • Gomez D.
        • Haas B.
        • Doumouras A.G.
        • et al.
        A population-based analysis of the discrepancy between potential and realized access to trauma center care.
        Ann Surg. 2013; 257: 160-165
        • Tillmann B.W.
        • Nathens A.B.
        • Guttman M.P.
        • et al.
        Hospital resources do not predict accuracy of secondary trauma triage: a population-based analysis.
        J Trauma Acute Care Surg. 2020; 88: 230-241
        • MacKenzie E.J.
        • Rivara F.P.
        • Jurkovich G.J.
        • et al.
        A national evaluation of the effect of trauma-center care on mortality.
        N Engl J Med. 2006; 354: 366-378
        • Haas B.
        • Gomez D.
        • Xiong W.
        • et al.
        External benchmarking of trauma center performance: have we forgotten our elders?.
        Ann Surg. 2011; 253: 144-150
        • Pandya S.R.
        • Yelon J.A.
        • Sullivan T.S.
        • et al.
        Geriatric motor vehicle collision survival: the role of institutional trauma volume.
        J Trauma. 2011; 70: 1326-1330
        • Zafar S.N.
        • Obirieze A.
        • Schneider E.B.
        • et al.
        Outcomes of trauma care at centers treating a higher proportion of older patients: the case for geriatric trauma centers.
        J Trauma Acute Care Surg. 2015; 78: 852-859
        • Olufajo O.A.
        • Metcalfe D.
        • Rios-Diaz A.
        • et al.
        Does hospital experience rather than volume improve outcomes in geriatric trauma patients?.
        J Am Coll Surg. 2016; 223: 32-40.e1
        • Bryan Y.
        • Johnson K.
        • Botros D.
        • et al.
        Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management.
        Clin Interv Aging. 2015; : 1925https://doi.org/10.2147/CIA.S93796
        • Langeron O.
        • Masso E.
        • Huraux C.
        • et al.
        Prediction of difficult mask ventilation.
        Anesthesiology. 2000; 92: 1229-1236
        • Kheterpal S.
        • Han R.
        • Tremper K.K.
        • et al.
        Incidence and predictors of difficult and impossible mask ventilation.
        Anesthesiology. 2006; 105: 885-891
        • Kheterpal S.
        • Martin L.
        • Shanks A.M.
        • et al.
        Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics.
        Anesthesiology. 2009; 110: 891-897
        • Detsky M.E.
        • Jivraj N.
        • Adhikari N.K.
        • et al.
        Will this patient be difficult to intubate?.
        JAMA. 2019; 321: 493
        • Goutcher C.M.
        • Lochhead V.
        Reduction in mouth opening with semi-rigid cervical collars † †Presented as a poster at the Difficult Airway Society Annual Scientific Meeting, Leicester, UK, November 25–26, 2004.
        Br J Anaesth. 2005; 95: 344-348
        • Yuk M.
        • Yeo W.
        • Lee K.
        • et al.
        Cervical collar makes difficult airway: a simulation study using the LEMON criteria.
        Clin Exp Emerg Med. 2018; 5: 22-28
        • Thiboutot F.
        • Nicole P.C.
        • Trépanier C.A.
        • et al.
        Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial.
        Can J Anesth Can D’anesthésie. 2009; 56: 412-418
        • Lewis S.R.
        • Butler A.R.
        • Parker J.
        • et al.
        Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review.
        Br J Anaesth. 2017; 119: 369-383
        • Singleton B.N.
        • Morris F.K.
        • Yet B.
        • et al.
        Effectiveness of intubation devices in patients with cervical spine immobilisation: a systematic review and network meta-analysis.
        Br J Anaesth. 2021; 126: 1055-1066
        • Sprung J.
        • Gajic O.
        • Warner D.O.
        Review article: age related alterations in respiratory function:- anesthetic considerations.
        Can J Anaesth. 2006; 53: 1244-1257
        • Dimitriou R.
        • Calori G.M.
        • Giannoudis P.V.
        Polytrauma in the elderly: specific considerations and current concepts of management.
        Eur J Trauma Emerg Surg. 2011; 37: 539-548
        • Rivera R.
        • Antognini J.F.
        • Riou B.
        Perioperative drug therapy in elderly patients.
        Anesthesiology. 2009; 110: 1176-1181
        • Upchurch C.P.
        • Grijalva C.G.
        • Russ S.
        • et al.
        Comparison of etomidate and ketamine for induction during rapid sequence intubation of adult trauma patients.
        Ann Emerg Med. 2017; 69: 24-33.e2
        • Kovacs G.
        • Sowers N.
        Airway management in trauma.
        Emerg Med Clin North Am. 2018; 36: 61-84
        • Matchett G.
        • Gasanova I.
        • Riccio C.A.
        • et al.
        Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial.
        Intensive Care Med. 2022; 48: 78-91
        • Callaway D.W.
        • Shapiro N.I.
        • Donnino M.W.
        • et al.
        Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients.
        J Trauma. 2009; 66: 1040-1044
        • Davis J.W.
        • Kaups K.L.
        Base deficit in the elderly: a marker of severe injury and death.
        J Trauma. 1998; 45: 873-877
        • Salottolo K.M.
        • Mains C.W.
        • Offner P.J.
        • et al.
        A retrospective analysis of geriatric trauma patients: venous lactate is a better predictor of mortality than traditional vital signs.
        Scand J Trauma Resusc Emerg Med. 2013; 21: 7
        • Neville A.L.
        • Nemtsev D.
        • Manasrah R.
        • et al.
        Mortality risk stratification in elderly trauma patients based on initial arterial lactate and base deficit levels.
        Am Surg. 2011; 77 (Available at:): 1337-1341
        • Sedighi S.M.
        • Nguyen M.
        • Khalil A.
        • et al.
        The impact of cardiac troponin in elderly patients in the absence of acute coronary syndrome: a systematic review.
        Int J Cardiol Hear Vasc. 2020; 31: 100629
        • Ivascu F.A.
        • Howells G.A.
        • Junn F.S.
        • et al.
        Rapid warfarin reversal in anticoagulated patients with traumatic intracranial hemorrhage reduces hemorrhage progression and mortality.
        J Trauma. 2005; 59 ([discussion: 1137–9]): 1131-1137
        • Liu H.
        • Yang Y.
        • Xia Y.
        • et al.
        Aging of cerebral white matter.
        Ageing Res Rev. 2017; 34: 64-76
        • Mosenthal A.C.
        • Livingston D.H.
        • Lavery R.F.
        • et al.
        The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial.
        J Trauma. 2004; 56: 1042-1048
        • McIntyre A.
        • Mehta S.
        • Aubut J.
        • et al.
        Mortality among older adults after a traumatic brain injury: a meta-analysis.
        Brain Inj. 2013; 27: 31-40
        • Thompson H.J.
        • Dikmen S.
        • Temkin N.
        Prevalence of comorbidity and its association with traumatic brain injury and outcomes in older adults.
        Res Gerontol Nurs. 2012; 5: 17-24
        • Coronado V.G.
        • Thomas K.E.
        • Sattin R.W.
        • et al.
        The CDC traumatic brain injury surveillance system: characteristics of persons aged 65 years and older hospitalized with a TBI.
        J Head Trauma Rehabil. 2005; 20: 215-228
        • Harvey L.A.
        • Close J.C.T.
        Traumatic brain injury in older adults: characteristics, causes and consequences.
        Injury. 2012; 43: 1821-1826
        • Kehoe A.
        • Rennie S.
        • Smith J.E.
        Glasgow Coma Scale is unreliable for the prediction of severe head injury in elderly trauma patients.
        Emerg Med J. 2015; 32: 613-615
        • Salottolo K.
        • Levy A.S.
        • Slone D.S.
        • et al.
        The effect of age on Glasgow Coma Scale score in patients with traumatic brain injury.
        JAMA Surg. 2014; 149: 727-734
        • Susman M.
        • DiRusso S.M.
        • Sullivan T.
        • et al.
        Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity.
        J Trauma. 2002; 53 ([discussion: 223–4]): 219-223
        • Demetriades D.
        • Kuncir E.
        • Murray J.
        • et al.
        Mortality prediction of head Abbreviated Injury Score and Glasgow Coma Scale: analysis of 7,764 head injuries.
        J Am Coll Surg. 2004; 199: 216-222
        • Mower W.R.
        • Hoffman J.R.
        • Herbert M.
        • et al.
        Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients.
        J Trauma. 2005; 59: 954-959
        • Stiell I.G.
        • Clement C.M.
        • Rowe B.H.
        • et al.
        Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury.
        JAMA. 2005; 294: 1511-1518
        • Jagoda A.S.
        • Bazarian J.J.
        • Bruns J.J.
        • et al.
        Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting.
        J Emerg Nurs. 2009; 35: e5-e40
        • Lomoschitz F.M.
        • Blackmore C.C.
        • Mirza S.K.
        • et al.
        Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries.
        AJR Am J Roentgenol. 2002; 178: 573-577
        • Healey C.D.
        • Spilman S.K.
        • King B.D.
        • et al.
        Asymptomatic cervical spine fractures: current guidelines can fail older patients.
        J Trauma Acute Care Surg. 2017; 83: 119-125
        • Schrag S.P.
        • Toedter L.J.
        • McQuay N.
        Cervical spine fractures in geriatric blunt trauma patients with low-energy mechanism: are clinical predictors adequate?.
        Am J Surg. 2008; 195: 170-173
        • Sadro C.T.
        • Sandstrom C.K.
        • Verma N.
        • et al.
        Geriatric trauma: a radiologist’s guide to imaging trauma patients aged 65 years and older.
        Radiographics. 2015; 35: 1263-1285
        • Stiell I.G.
        • Wells G.A.
        • Vandemheen K.L.
        • et al.
        The Canadian C-spine rule for radiography in alert and stable trauma patients.
        JAMA. 2001; 286: 1841-1848
        • Goode T.
        • Young A.
        • Wilson S.P.
        • et al.
        Evaluation of cervical spine fracture in the elderly: can we trust our physical examination?.
        Am Surg. 2014; 80: 182-184
        • Touger M.
        • Gennis P.
        • Nathanson N.
        • et al.
        Validity of a decision rule to reduce cervical spine radiography in elderly patients with blunt trauma.
        Ann Emerg Med. 2002; 40: 287-293
        • Denver D.
        • Shetty A.
        • Unwin D.
        Falls and Implementation of NEXUS in the Elderly (The FINE Study).
        J Emerg Med. 2015; 49: 294-300
        • Bub L.D.
        • Blackmore C.C.
        • Mann F.A.
        • et al.
        Cervical spine fractures in patients 65 years and older: a clinical prediction rule for blunt trauma.
        Radiology. 2005; 234: 143-149
        • Como J.J.
        • Diaz J.J.
        • Dunham C.M.
        • et al.
        Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee.
        J Trauma. 2009; 67: 651-659
        • Laksmi P.W.
        • Harimurti K.
        • Setiati S.
        • et al.
        Management of immobilization and its complication for elderly.
        Acta Med Indones. 2008; 40 (Available at:): 233-240
        • Powers J.
        • Daniels D.
        • McGuire C.
        • et al.
        The incidence of skin breakdown associated with use of cervical collars.
        J Trauma Nurs. 2006; 13: 198-200
        • Patel M.B.
        • Humble S.S.
        • Cullinane D.C.
        • et al.
        Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma.
        J Trauma Acute Care Surg. 2015; 78: 430-441
        • Rao P.J.
        • Phan K.
        • Mobbs R.J.
        • et al.
        Cervical spine immobilization in the elderly population.
        J Spine Surg (Hong Kong). 2016; 2: 41-46
        • Ziegler D.W.
        • Agarwal N.N.
        The morbidity and mortality of rib fractures.
        J Trauma. 1994; 37: 975-979
        • Liman S.T.
        • Kuzucu A.
        • Tastepe A.I.
        • et al.
        Chest injury due to blunt trauma.
        Eur J Cardiothorac Surg. 2003; 23: 374-378
        • Marini C.P.
        • Petrone P.
        • Soto-Sánchez A.
        • et al.
        Predictors of mortality in patients with rib fractures.
        Eur J Trauma Emerg Surg. 2021; 47: 1527-1534
        • Stawicki S.P.
        • Grossman M.D.
        • Hoey B.A.
        • et al.
        Rib fractures in the elderly: a marker of injury severity.
        J Am Geriatr Soc. 2004; 52: 805-808
        • Shi H.H.
        • Esquivel M.
        • Staudenmayer K.L.
        • et al.
        Effects of mechanism of injury and patient age on outcomes in geriatric rib fracture patients.
        Trauma Surg Acute Care Open. 2017; 2: e000074
        • Battle C.E.
        • Hutchings H.
        • Evans P.A.
        Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis.
        Injury. 2012; 43: 8-17
        • Barnea Y.
        • Kashtan H.
        • Skornick Y.
        • et al.
        Isolated rib fractures in elderly patients: mortality and morbidity.
        Can J Surg. 2002; 45 (Available at:): 43-46
        • Meyer D.E.
        • Vincent L.E.
        • Fox E.E.
        • et al.
        Every minute counts: time to delivery of initial massive transfusion cooler and its impact on mortality.
        J Trauma Acute Care Surg. 2017; https://doi.org/10.1097/TA.0000000000001531
        • Bergeron E.
        • Lavoie A.
        • Clas D.
        • et al.
        Elderly trauma patients with rib fractures are at greater risk of death and pneumonia.
        J Trauma. 2003; 54: 478-485
        • Bulger E.M.
        • Arneson M.A.
        • Mock C.N.
        • et al.
        Rib fractures in the elderly.
        J Trauma. 2000; 48 ([discussion: 1046–7]): 1040-1046
        • Sirmali M.
        • Türüt H.
        • Topçu S.
        • et al.
        A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management.
        Eur J Cardiothorac Surg. 2003; 24: 133-138
        • Shulzhenko N.O.
        • Zens T.J.
        • Beems M.V.
        • et al.
        Number of rib fractures thresholds independently predict worse outcomes in older patients with blunt trauma.
        Surgery. 2017; 161: 1083-1089
        • Livingston D.H.
        • Shogan B.
        • John P.
        • et al.
        CT diagnosis of rib fractures and the prediction of acute respiratory failure.
        J Trauma. 2008; 64: 905-911
        • Galvagno S.M.
        • Smith C.E.
        • Varon A.J.
        • et al.
        Pain management for blunt thoracic trauma: a joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society.
        J Trauma Acute Care Surg. 2016; 81: 936-951
        • Brasel K.J.
        • Moore E.E.
        • Albrecht R.A.
        • et al.
        Western Trauma Association critical decisions in trauma: management of rib fractures.
        J Trauma Acute Care Surg. 2017; 82: 200-203
        • Billings J.D.
        • Khan A.D.
        • Clement L.P.
        • et al.
        A clinical practice guideline using percentage of predicted forced vital capacity improves resource allocation for rib fracture patients.
        J Trauma Acute Care Surg. 2021; 90: 769-775
        • Carver T.W.
        • Milia D.J.
        • Somberg C.
        • et al.
        Vital capacity helps predict pulmonary complications after rib fractures.
        J Trauma Acute Care Surg. 2015; 79: 413-416
        • Warner R.
        • Knollinger P.
        • Hobbs G.
        • et al.
        Forced vital capacity less than 1: a mark for high-risk patients.
        J Trauma Acute Care Surg. 2018; 85: 271-274
        • Sahr S.M.
        • Webb M.L.
        • Renner C.H.
        • et al.
        Implementation of a rib fracture triage protocol in elderly trauma patients.
        J Trauma Nurs. 2013; 20 ([quiz: 176–7]): 172-175
        • Hamilton C.
        • Barnett L.
        • Trop A.
        • et al.
        Emergency department management of patients with rib fracture based on a clinical practice guideline.
        Trauma Surg Acute Care Open. 2017; 2: e000133
        • Flarity K.
        • Rhodes W.C.
        • Berson A.J.
        • et al.
        Guideline-driven care improves outcomes in patients with traumatic rib fractures.
        Am Surg. 2017; 83 (Available at:): 1012-1017
        • Todd S.R.
        • McNally M.M.
        • Holcomb J.B.
        • et al.
        A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients.
        Am J Surg. 2006; 192: 806-811
        • Veronese N.
        • Maggi S.
        Epidemiology and social costs of hip fracture.
        Injury. 2018; 49: 1458-1460
        • Cannon J.
        • Silvestri S.
        • Munro M.
        Imaging choices in occult hip fracture.
        J Emerg Med. 2009; 37: 144-152
        • Uzoigwe C.E.
        • Burnand H.G.F.
        • Cheesman C.L.
        • et al.
        Early and ultra-early surgery in hip fracture patients improves survival.
        Injury. 2013; 44: 726-729
        • Simunovic N.
        • Devereaux P.J.
        • Sprague S.
        • et al.
        Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis.
        CMAJ. 2010; 182: 1609-1616
        • HIP ATTACK Investigators
        Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial.
        Lancet (London, England). 2020; 395: 698-708
        • Patel J.N.
        • Klein D.S.
        • Sreekumar S.
        • et al.
        Outcomes in multidisciplinary team-based approach in geriatric hip fracture care: a systematic review.
        J Am Acad Orthop Surg. 2020; 28: 128-133
        • Zuckerman J.D.
        • Sakales S.R.
        • Fabian D.R.
        • et al.
        Hip fractures in geriatric patients. Results of an interdisciplinary hospital care program.
        Clin Orthop Relat Res. 1992; 274 (Available at:): 213-225
        • Lau T.W.
        • Leung F.
        • Siu D.
        • et al.
        Geriatric hip fracture clinical pathway: the Hong Kong experience.
        Osteoporos Int. 2010; 21: S627-S636
        • Adunsky A.
        • Lerner-Geva L.
        • Blumstein T.
        • et al.
        Improved survival of hip fracture patients treated within a comprehensive geriatric hip fracture unit, compared with standard of care treatment.
        J Am Med Dir Assoc. 2011; 12: 439-444
        • Schnell S.
        • Friedman S.M.
        • Mendelson D.A.
        • et al.
        The 1-year mortality of patients treated in a hip fracture program for elders.
        Geriatr Orthop Surg Rehabil. 2010; 1: 6-14
        • Giannoulis D.
        • Calori G.M.
        • Giannoudis P.V.
        Thirty-day mortality after hip fractures: has anything changed?.
        Eur J Orthop Surg Traumatol. 2016; 26: 365-370
        • Lau T.-W.
        • Fang C.
        • Leung F.
        The effectiveness of a geriatric hip fracture clinical pathway in reducing hospital and rehabilitation length of stay and improving short-term mortality rates.
        Geriatr Orthop Surg Rehabil. 2013; 4: 3-9
        • Moyet J.
        • Deschasse G.
        • Marquant B.
        • et al.
        Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice.
        Int Orthop. 2019; 43: 1449-1454
        • Henry S.M.
        • Pollak A.N.
        • Jones A.L.
        • et al.
        Pelvic fracture in geriatric patients: a distinct clinical entity.
        J Trauma. 2002; 53: 15-20
        • Kanezaki S.
        • Miyazaki M.
        • Notani N.
        • et al.
        Clinical presentation of geriatric polytrauma patients with severe pelvic fractures: comparison with younger adult patients.
        Eur J Orthop Surg Traumatol. 2016; 26: 885-890
        • Kimbrell B.J.
        • Velmahos G.C.
        • Chan L.S.
        • et al.
        Angiographic embolization for pelvic fractures in older patients.
        Arch Surg. 2004; 139 ([discussion: 732–3]): 728-732
        • Farage M.A.
        • Miller K.W.
        • Elsner P.
        • et al.
        Characteristics of the aging skin.
        Adv Wound Care. 2013; 2: 5-10
        • Stagg M.J.
        • Lovell M.E.
        A repeat audit of spinal board usage in the emergency department.
        Injury. 2008; 39: 323-326
        • Gefen A.
        How much time does it take to get a pressure ulcer? Integrated evidence from human, animal, and in vitro studies.
        Ostomy Wound Manage. 2008; 54 (30-35): 26-28
        • Kwan I.
        • Bunn F.
        • Roberts I.
        Spinal immobilisation for trauma patients.
        Cochrane Database Syst Rev. 2001; : CD002803
        • Shi C.
        • Dumville J.C.
        • Cullum N.
        • et al.
        Beds, overlays and mattresses for preventing and treating pressure ulcers: an overview of Cochrane Reviews and network meta-analysis.
        Cochrane Database Syst Rev. 2021; : 2021https://doi.org/10.1002/14651858.CD013761.pub2
        • Van Tiggelen H.
        • LeBlanc K.
        • Campbell K.
        • et al.
        Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries.
        Br J Dermatol. 2020; 183: 146-154
        • LeBlanc K.
        • Campbell K.E.
        • Wood E.
        • et al.
        Best practice recommendations for prevention and management of skin tears in aged skin: an overview.
        J Wound Ostomy Cont Nurs. 2018; 45: 540-542
        • LeBlanc K.
        • Baranoski S.
        Skin Tear Consensus Panel Members. Skin tears: state of the science: consensus statements for the prevention, prediction, assessment, and treatment of skin tears.
        Adv Skin Wound Care. 2011; 24: 2-15
        • Pillemer K.
        • Burnes D.
        • Riffin C.
        • et al.
        Elder abuse: global situation, risk factors, and prevention strategies.
        Gerontologist. 2016; 56: S194-S205
        • Yon Y.
        • Mikton C.R.
        • Gassoumis Z.D.
        • et al.
        Elder abuse prevalence in community settings: a systematic review and meta-analysis.
        Lancet Glob Heal. 2017; 5: e147-e156
        • Dong X.
        • Simon M.A.
        Association between elder abuse and use of ED: findings from the Chicago Health and Aging Project.
        Am J Emerg Med. 2013; 31: 693-698
        • Mercier É.
        • Nadeau A.
        • Brousseau A.-A.
        • et al.
        Elder abuse in the out-of-hospital and emergency department settings: a scoping review.
        Ann Emerg Med. 2020; 75: 181-191
        • Mandiracioglu A.
        • Govsa F.
        • Celikli S.
        • et al.
        Emergency health care personnel’s knowledge and experience of elder abuse in Izmir.
        Arch Gerontol Geriatr. 2006; 43: 267-276
        • Storey J.E.
        Risk factors for elder abuse and neglect: a review of the literature.
        Aggress Violent Behav. 2020; 50: 101339
        • Rosen T.
        • Hargarten S.
        • Flomenbaum N.E.
        • et al.
        Identifying elder abuse in the emergency department: toward a multidisciplinary team-based approach.
        Ann Emerg Med. 2016; 68: 378-382
        • Gallione C.
        • Dal Molin A.
        • Cristina F.V.B.
        • et al.
        Screening tools for identification of elder abuse: a systematic review.
        J Clin Nurs. 2017; 26: 2154-2176
        • Abuse C.
        • Abuse E.
        • Violence I.P.
        • et al.
        Best practices guidelines for trauma center recognition of child abuse, elder abuse.
        Am Coll Surg. 2019; : 52-53
      2. Palliative Care Best Practices Guidelines. American College of Surgeons.
        (Available at:) (Accessed August 20, 2022)
        • Burton J.K.
        • Craig L.E.
        • Yong S.Q.
        • et al.
        Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients.
        Cochrane Database Syst Rev. 2021; 2021https://doi.org/10.1002/14651858.CD013307.pub2
        • By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel
        American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults.
        J Am Geriatr Soc. 2019; 67: 674-694
        • Fallon W.F.
        • Rader E.
        • Zyzanski S.
        • et al.
        Geriatric outcomes are improved by a geriatric trauma consultation service.
        J Trauma. 2006; 61: 1040-1046
        • Lenartowicz M.
        • Parkovnick M.
        • McFarlan A.
        • et al.
        An evaluation of a proactive geriatric trauma consultation service.
        Ann Surg. 2012; 256: 1098-1101
        • Eagles D.
        • Godwin B.
        • Cheng W.
        • et al.
        A systematic review and meta-analysis evaluating geriatric consultation on older trauma patients.
        J Trauma Acute Care Surg. 2020; 88: 446-453