BACKGROUND The demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. This study investigated whether the integration of new standard operating procedures (SOPs) for the resuscitation room (ER) has an impact on the clinical course in geriatric patients. The new SOPs were designed for severely injured adult trauma patients, based on the Advanced Trauma Life Support (ATLS) and imply early whole-body computed tomography (CT), damage control surgery, and the use of goal-directed coagulation management. METHODS Single-centre cohort study. We included all patients ≥65 years of age with an Injury Severity Score (ISS) ≥ 9 who were admitted to our hospital primarily via ER. A historic cohort was compared to a cohort after the implementation of the new SOPs. RESULTS We enrolled 311 patients who met the inclusion criteria between 2000 and 2006 (group PreSOP) and 2010-2012 (group SOP). There was a significant reduction in the mortality rate after the implementation of the new SOPs (P = .001). This benefit was seen only for severely injured patients (ISS ≥ 16), but not for moderately injured patients (ISS 9-15). There were no differences with regard to infection rates or rate of palliative care. CONCLUSIONS We found an association between implementation of new ER SOPs, and a lower mortality rate in severely injured geriatric trauma patients, whereas moderately injured patients did not obtain the same benefit. TRIAL REGISTRATION Clinicaltrials.gov NCT03319381, retrospectively registered 24 October 2017.

中文翻译：

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对多发伤老年创伤患者实施新标准操作程序：一项一级创伤中心研究。

背景技术发达国家人口老龄化的人口变化给创伤中心带来了挑战，因为老年创伤患者需要特定的诊断和治疗程序。本研究调查了复苏室 (ER) 新标准操作程序 (SOP) 的整合是否对老年患者的临床过程产生影响。新的 SOP 是为严重受伤的成年创伤患者设计的，基于高级创伤生命支持 (ATLS)，意味着早期全身计算机断层扫描 (CT)、损伤控制手术以及目标导向凝血管理的使用。方法 单中心队列研究。我们纳入了所有年龄 ≥65 岁、损伤严重程度评分 (ISS) ≥ 9、主要通过急诊室入院的患者。将历史队列与实施新标准操作程序后的队列进行比较。结果 我们招募了 2000 年至 2006 年（PreSOP 组）和 2010-2012 年（SOP 组）期间符合纳入标准的 311 名患者。实施新 SOP 后死亡率显着降低 (P = .001)。这种益处仅适用于严重受伤的患者 (ISS ≥ 16)，但不适用于中度受伤的患者 (ISS 9-15)。感染率或姑息治疗率没有差异。结论 我们发现，实施新的急诊室标准操作程序与严重受伤的老年创伤患者较低的死亡率之间存在关联，而中度受伤的患者则没有获得相同的益处。试验注册 ClinicalTrials.gov NCT03319381，于 2017 年 10 月 24 日回顾注册。