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Module 7: Head Injuries

Segment 1: The Geriatric Trauma Patient

References labeled PEDS contain a pediatric element or primary focus.

Topic: The geriatric trauma patient

  • Agoubi LL, Reimel BA, Maine RG, et al. Intensive care unit readmission in injured older adults: Modifiable risk factors and implications. J Trauma Acute Care Surg. 2024;96(5):813-819. doi: 10.1097/ta.0000000000004203 https://pubmed.ncbi.nlm.nih.gov/37926991/.
  • Ahl R, Phelan HA, Dogan S, et al. Predicting in-hospital and 1-year mortality in geriatric trauma patients using the Geriatric Trauma Outcome Score. J Am Coll Surg. 2017;224(3):264-269. doi: 10.1016/j.jamcollsurg.2016.12.011 https://pubmed.ncbi.nlm.nih.gov/28017806/.
  • Alizai Q, Colosimo C, Hosseinpour H, et al. It is not all black and white: The effect of increasing severity of frailty on outcomes of geriatric trauma patients. J Trauma Acute Care Surg. 2024;96(3):434-442. doi: 10.1097/ta.0000000000004217 https://pubmed.ncbi.nlm.nih.gov/37994092/.
  • Alouidor R, Siu M, Roh S, et al. Impact of modified geriatric trauma activation criteria on patient outcomes at a Level I trauma center. Trauma. 2024;26(1):7-14. doi: 10.1177/14604086221110972 https://journals.sagepub.com/doi/abs/10.1177/14604086221110972.
  • American College of Surgeons. Best practice guidelines: Geriatric trauma management. 2023. https://www.facs.org/media/ubyj2ubl/best-practices-guidelines-geriatric-trauma.pdf.
  • American College of Surgeons Committee on Trauma. Best practices guidelines for trauma center recognition of child abuse, elder abuse, and intimate partner violence. 2019. https://www.facs.org/media/o0wdimys/abuse_guidelines.pdf.
  • Badell CS, Lizarazo Jimenez M, Lopez Jesus AI, et al. Differences in intensive care outcomes between older adults with and without dementia: A systematic review and meta-analysis. J Crit Care. 2026;94:155553. doi: 10.1016/j.jcrc.2026.155553 https://pubmed.ncbi.nlm.nih.gov/41933548/.
  • Barker A, Cameron P, Flicker L, et al. Evaluation of RESPOND, a patient-centred program to prevent falls in older people presenting to the emergency department with a fall: A randomised controlled trial. PLoS Med. 2019;16(5):e1002807. doi: 10.1371/journal.pmed.1002807 https://pubmed.ncbi.nlm.nih.gov/31125354/.
  • Boland S, Lu L, Byrd T, et al. Drowning in the silver tsunami: Geriatric patient proportion impact on trauma outcomes. Surgery. 2025;187:109651. doi: 10.1016/j.surg.2025.109651 https://pubmed.ncbi.nlm.nih.gov/40953533/.
  • Brown R, Gatfield S, Rogers M, et al. Clinical frailty score: A useful tool in predicting outcomes in patients with fragility fractures. Trauma. 2024;26(1):20-27. doi: 10.1177/14604086221112823 https://journals.sagepub.com/doi/abs/10.1177/14604086221112823.
  • Cenzer IS, Tang V, Boscardin WJ, et al. One-year mortality after hip fracture: Development and validation of a prognostic index. J Am Geriatr Soc. 2016;64(9):1863-8. doi: 10.1111/jgs.14237 https://pubmed.ncbi.nlm.nih.gov/27295578/.
  • Cook AC, Joseph B, Inaba K, et al. Multicenter external validation of the Geriatric Trauma Outcome Score: A study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly (PALLIATE) consortium. J Trauma Acute Care Surg. 2016;80(2):204-9. doi: 10.1097/ta.0000000000000926 https://pubmed.ncbi.nlm.nih.gov/26595708/.
  • Criddle LM. 5-year survival of geriatric patients following trauma center discharge. Adv Emerg Nurs J. 2009;31(4):323-36. doi: 10.1097/TME.0b013e3181bd2a67 https://pubmed.ncbi.nlm.nih.gov/20118886/.
  • Cuevas-Østrem M, Wisborg T, Røise O, et al. Differences in time-critical interventions and radiological examinations between adult and older trauma patients: A national register-based study. J Trauma Acute Care Surg. 2022;93(4):503-512. doi: 10.1097/ta.0000000000003570 https://pubmed.ncbi.nlm.nih.gov/35137729/.
  • De Simone B, Chouillard E, Podda M, et al. The 2023 WSES guidelines on the management of trauma in elderly and frail patients. World J Emerg Surg. 2024;19(1):18. doi: 10.1186/s13017-024-00537-8 https://pubmed.ncbi.nlm.nih.gov/38816766/.
  • Erdle B, Pietsch C, Holzfurtner L, et al. Fall height is inversely associated with mortality in geriatric trauma patients undergoing trauma team activation and whole-body CT: A retrospective cohort analysis. Injury. 2026;57(10) doi: 10.1016/j.injury.2026.113522 https://pubmed.ncbi.nlm.nih.gov/42475934/.
  • Fakhry SM, Shen Y, Garland JM, et al. The burden of geriatric traumatic brain injury on trauma systems: Analysis of 348,800 Medicare inpatient claims. J Am Geriatr Soc. 2023;71(2):516-527. doi: 10.1111/jgs.18114 https://pubmed.ncbi.nlm.nih.gov/36330687/.
  • Falon J, Samarasinghe P, Elhindi J, et al. The road less recovered: Examining the effect of trauma on frailty trajectories in older patients. J Trauma Acute Care Surg. 2025;doi: 10.1097/ta.0000000000004751 https://pubmed.ncbi.nlm.nih.gov/40712059/.
  • Ferrante LE, Chaudhuri D, Laiya Carayannopoulos K, et al. Society of Critical Care Medicine guidelines on caring for older adults in the ICU. Crit Care Med. 2026;54(5):1060-1072. doi: 10.1097/ccm.0000000000007085 https://pubmed.ncbi.nlm.nih.gov/41860322/.
  • Fields AC, Castillo-Angeles M, Bryan MR, et al. Rib fracture injury guidelines for patients over the age of 65: Should these patients routinely be admitted to the intensive care unit? J Surg Res. 2025;315:443-450. doi: 10.1016/j.jss.2025.09.051 https://pubmed.ncbi.nlm.nih.gov/41086662/.
  • Fields DP, Varga G, Alattar A, et al. Preinjury frailty predicts 1-year mortality in older adults with traumatic spine fractures. Neurosurgery. 2024;doi: 10.1227/neu.0000000000002913 https://pubmed.ncbi.nlm.nih.gov/38551355/.
  • Fletcher J, Morello V, Gurbanov E, et al. Age matters: Elevated mortality and distinct injury patterns in elderly (≥75 years) patients with high-energy pelvic ring injuries. Injury. 2026;57(2):112963. doi: 10.1016/j.injury.2025.112963 https://pubmed.ncbi.nlm.nih.gov/41418384/.
  • Ghafarian AM, Wajahath M, McBee K, et al. One-year mortality after first-time long bone fractures in older adults: A multicenter retrospective cohort study. Injury. 2026;doi: 10.1016/j.injury.2026.113348 https://pubmed.ncbi.nlm.nih.gov/42107204/.
  • Griffiths R, Surendra Kumar D. Major trauma in older people: implications for anaesthesia and intensive care medicine. Anaesthesia. 2017;72(11):1302-1305. doi: 10.1111/anae.14027 https://pubmed.ncbi.nlm.nih.gov/28832941/.
  • Guttman MP, Williams PJ, Tillmann BW, et al. The need for long-term support: Five-year outcomes after severe injury in older adults. Injury. 2026;57(6):113194. doi: 10.1016/j.injury.2026.113194 https://pubmed.ncbi.nlm.nih.gov/41932165/.
  • Heffernan DS, Thakkar RK, Monaghan SF, et al. Normal presenting vital signs are unreliable in geriatric blunt trauma victims. J Trauma. 2010;69(4):813-20. doi: 10.1097/TA.0b013e3181f41af8 https://pubmed.ncbi.nlm.nih.gov/20938267/.
  • Isaac CJ, Benhamed A, Boucher V, et al. The increased mortality of older patients with moderate traumatic brain injury. CJEM. 2026;28(1):42-47. doi: 10.1007/s43678-025-00941-2 https://pubmed.ncbi.nlm.nih.gov/40451992/.
  • Joseph B, Saljuqi AT, Phuong J, et al. Developing a National Trauma Research Action Plan (NTRAP): Results from the Geriatric Research Gap Delphi Survey. J Trauma Acute Care Surg. 2022;doi: 10.1097/ta.0000000000003626 https://pubmed.ncbi.nlm.nih.gov/35972140/.
  • Keiser M, Buterakos R, Gillespie S, et al. Frailty screening in geriatric trauma: A pilot feasibility study. J Trauma Nurs. 2023;30(1):34-40. doi: 10.1097/jtn.0000000000000697 https://pubmed.ncbi.nlm.nih.gov/36633343/.
  • Khadaroo RG, Warkentin LM, Wagg AS, et al. Clinical effectiveness of the Elder-Friendly Approaches to the Surgical Environment initiative in emergency general surgery. JAMA Surg. 2020:e196021. doi: 10.1001/jamasurg.2019.6021 https://pubmed.ncbi.nlm.nih.gov/32049271/.
  • Khurshid MH, Hejazi O, Castillo Diaz F, et al. Resuscitation in geriatric trauma: Does volume-outcome relationship still hold? J Surg Res. 2025;315:883-889. doi: 10.1016/j.jss.2025.10.007 https://pubmed.ncbi.nlm.nih.gov/41197585/.
  • Kirshenbom D, Ben-Zaken Z, Albilya N, et al. Older age, comorbid illnesses, and injury severity affect immediate outcome in elderly trauma patients. J Emerg Trauma Shock. 2017;10(3):146-150. doi: 10.4103/jets.jets_62_16 https://pubmed.ncbi.nlm.nih.gov/28855778/.
  • Kocar TD, Fotteler ML, Willems J, et al. Evidence-based recommendations for geriatric trauma care: Systematic review and AI-assisted consolidation of clinical practice guidelines between 2016 and 2021. Ann Surg Open. 2025;6(4):e627. doi: 10.1097/as9.0000000000000627 https://journals.lww.com/aosopen/fulltext/2025/12000/evidence_based_recommendations_for_geriatric.17.aspx.
  • Koch MAG-R, Arleth T, Rosenkrantz O, et al. Interhospital transfers in elderly trauma patients. Injury. 2025;56(1) doi: 10.1016/j.injury.2024.111998 https://pubmed.ncbi.nlm.nih.gov/39550344/.
  • Kojima M, Morishita K, Shoko T, et al. Does frailty impact failure-to-rescue in geriatric trauma patients? J Trauma Acute Care Surg. 2024;96(5):708-714. doi: 10.1097/ta.0000000000004256 https://pubmed.ncbi.nlm.nih.gov/38196096/.
  • Lee SY, Song KJ, Hong KJ, et al. Epidemiology and outcomes of geriatric patients with severe injury in Korea: Nationwide community-based study, 2016-2023. Injury. 2026;57(9) doi: 10.1016/j.injury.2026.113425 https://doi.org/10.1016/j.injury.2026.113425.
  • Lesko K, Deasy C. Low falls causing major injury: a retrospective study. Ir J Med Sci. 2020;189(4):1435-1443. doi: 10.1007/s11845-020-02212-8 https://pubmed.ncbi.nlm.nih.gov/32185749/.
  • Lockie E, Shakerian R, Gregorevic K, et al. Frailty ‐ The strongest predictor of 12‐month mortality in minor and major elderly trauma. Trauma. 2022;24(4):322-326. doi: 10.1177/14604086211019182 https://journals.sagepub.com/doi/abs/10.1177/14604086211019182.
  • Matter AL, Pierce MF, Beal JR, et al. Factors associated with older adult fracture visits to United States emergency departments, 2013–2022. Injury. 2026;doi: 10.1016/j.injury.2026.113374 https://pubmed.ncbi.nlm.nih.gov/42214828/.
  • McDuffie JV, L’Huillier JC, Nohra E, et al. Geriatric Age is an Independent Risk Factor for Worse Clinical Outcomes After Motorcycle Collision. J Surg Res. 2026;325:631-639. doi: 10.1016/j.jss.2026.05.063 https://pubmed.ncbi.nlm.nih.gov/42385652/.
  • Mower WR, Akie TE, Morizadeh N, et al. Blunt head injury in the elderly: Analysis of the NEXUS II injury cohort. Ann Emerg Med. 2024;83(5):457-466. doi: 10.1016/j.annemergmed.2024.01.003 https://pubmed.ncbi.nlm.nih.gov/38340132/.
  • Noureldin A, Matecki M, Li R, et al. Should we redefine the age of geriatric trauma? An insight from American College of Surgeons Trauma Quality Improvement Program database 30-day mortality risk. J Trauma Acute Care Surg. 2025;99(1):128-134. doi: 10.1097/ta.0000000000004611 https://pubmed.ncbi.nlm.nih.gov/40170234/.
  • Nunes N, Nasef H, Baum S, et al. Outcomes of adult & geriatric trauma patients with severe traumatic brain injury treated at level I or II ACS-verified trauma centers: Towards optimizing geriatric trauma care. Am J Emerg Med. 2026;101:61-70. doi: 10.1016/j.ajem.2025.12.027 https://pubmed.ncbi.nlm.nih.gov/41468620/.
  • O’Donohoe RB, Mathew J, Winter N, et al. The effectiveness of an early management guideline for older patients following blunt thoracic injury. Injury. 2026:113155. doi: 10.1016/j.injury.2026.113155 https://pubmed.ncbi.nlm.nih.gov/41881750/.
  • O’Rorke S, Tipping CJ, Lodge M, et al. Frailty across the adult age spectrum and its effects on outcomes: Experience from a level 1 trauma centre. Injury. 2025;56(2) doi: 10.1016/j.injury.2024.112037 https://pubmed.ncbi.nlm.nih.gov/39615310/.
  • Ordoobadi AJ, Wu C, Castillo-Angeles M, et al. Disparity in time to hemorrhage control surgery for injured older adults. J Trauma Acute Care Surg. 2026;100(1):105-112. doi: 10.1097/ta.0000000000004778 https://pubmed.ncbi.nlm.nih.gov/40875226/.
  • Palacio CH, Joseph D, Castater C, et al. Growing injury threats to longevity in the older population: American Association for the Surgery of Trauma Prevention Committee topical update. Trauma Surg Acute Care Open. 2025;10(2):e001526. doi: 10.1136/tsaco-2024-001526 https://pubmed.ncbi.nlm.nih.gov/40385319/.
  • Pandya S, Le T, Demissie S, et al. The association of gender and mortality in geriatric trauma patients. Healthcare (Basel). 2022;10(8) doi: 10.3390/healthcare10081472 https://pubmed.ncbi.nlm.nih.gov/36011129/.
  • Peterson AB, Kegler SR. Deaths from fall-related traumatic brain injury—United States, 2008–2017. MMWR Morb Mortal Wkly Rep. 2020;69(9):225-230. doi: 10.15585/mmwr.mm6909a2 https://pubmed.ncbi.nlm.nih.gov/32134910/.
  • Pollack LR, Liao J, Powelson EB, et al. Long-term health-related quality of life and independence among older survivors of serious injury. J Trauma Acute Care Surg. 2023;94(4):624-631. doi: 10.1097/ta.0000000000003864 https://pubmed.ncbi.nlm.nih.gov/36623274/.
  • Reyes AM, Shah M, Cobler-Lichter MD, et al. Frailty in older motorcycle riders increases the risk of chest trauma, mortality, and adverse discharge. Am J Surg. 2026;252:116763. doi: 10.1016/j.amjsurg.2025.116763 https://pubmed.ncbi.nlm.nih.gov/41371200/.
  • Rossum du Chattel AMv, Laane DWPM, Aydin FB, et al. Frailty as defined by the comprehensive geriatric assessment frailty index (CGA-FI) is associated with in-hospital complications and mortality in geriatric hip fracture patients, A retrospective cohort study. Injury. 2026;57(7) doi: 10.1016/j.injury.2026.113270 https://pubmed.ncbi.nlm.nih.gov/42085909/.
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  • Sangtani R. Frailty assessment enhances risk stratification in geriatric trauma: Supporting evidence from a recent injury cohort study. Injury. 2026;57(4):113143. doi: 10.1016/j.injury.2026.113143 https://pubmed.ncbi.nlm.nih.gov/41780467/.
  • Shen Y, Orlando A, Scott T, et al. Impact of trauma centers on survival in older vs younger adults: A propensity-weighted comparison of level 1 and level 3 trauma centers in the NTDB. J Trauma Acute Care Surg. 2026;doi: 10.1097/ta.0000000000005109 https://pubmed.ncbi.nlm.nih.gov/42413471/.
  • Sulej-Niemiec M, Żurowska-Wolak M, Kopta A, et al. Criteria for the qualification of geriatric patients to the trauma center. World J Emerg Surg. 2026;21(1) doi: 10.1186/s13017-026-00683-1 https://pubmed.ncbi.nlm.nih.gov/41796336/.
  • Tang P, Elkington O, Stevens S. Whole body CT-scan vs. selective CT-scan in geriatric trauma: Systematic review and meta-analysis. Trauma. 2025;0(0):14604086241304629. doi: 10.1177/14604086241304629 https://journals.sagepub.com/doi/abs/10.1177/14604086241304629.
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