Management of Trauma in Elderly and Frail Patients: A Master Summary of the 2023 WSES Guidelines

Management of Trauma in Elderly and Frail Patients: A Master Summary of the 2023 WSES Guidelines

Belinda De Simone¹‾², Fausto Catena¹‾³

1. Department of Emergency and General Minimally Invasive Surgery, Level I Trauma Center, Bufalini Hospital, AUSL Romagna, Cesena, Italy
2. Department of Theoretical and Applied Sciences, eCampus University, Novedrate, CO, Italy
3. Dept of Medical and Surgical Sciences  Alma Mater Studiorum University of Bologna Bologna  ITALY

Corresponding author

Belinda De Simone, MD, PhDc

Department of Emergency and General Minimally Invasive Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy; Department of Theoretical and Applied Sciences, eCampus University, Novedrate, CO, Italy

[email protected]

___________________________

Abstract

Background:
As global populations age, trauma in elderly and frail patients has emerged as a major public health challenge. Older adults experience disproportionately high morbidity and mortality after injury due to diminished physiological reserve, multimorbidity, polypharmacy, and frailty. In response to these growing complexities, the World Society of Emergency Surgery (WSES) developed the 2023 Guidelines on the Management of Trauma in Elderly and Frail Patients. This master summary synthesizes the core recommendations, evidence, and clinical principles to support standardized, frailty-oriented care throughout the trauma pathway.

Methods:
This work summarizes the main evidence and recommendations of the 2023 WSES Guidelines. The original guideline was produced through PRISMA-compliant systematic reviews and GRADE-based evidence appraisal by multidisciplinary international working groups. Consensus was finalized during the 10th WSES Congress. This summary organizes findings into key clinical domains to facilitate practical implementation.

Results:
The guidelines highlight frailty as the central determinant of outcomes, superseding chronological age. Early identification through validated tools (CFS, TSFI, GTOS) is recommended. A lower threshold for trauma activation, comprehensive imaging, and serial assessment of lactate/base deficit are essential to detect occult shock. Resuscitation should prioritize restrictive fluids, early correction of coagulopathy, judicious vasopressor use, and individualized hemodynamic targets. Additional core recommendations address anticoagulant reversal, multimodal analgesia, antibiotic stewardship, venous thromboembolism prophylaxis, nutritional support, delirium prevention, and structured end-of-life communication. System-level approaches, including geriatric trauma pathways, multidisciplinary teams, and outcome monitoring, are emphasized for implementation.

Conclusions:
The WSES guidelines reframe geriatric trauma care around individualized, frailty-driven assessment and management. Integrating physiologic principles, ethical sensitivity, and multidisciplinary coordination, they provide a comprehensive roadmap to improve survival, functional recovery, and quality of life in elderly trauma patients.

Key words: Geriatric trauma; Frailty; Elderly patients; Trauma management; WSES guidelines

Published online first*

Access full paper here: