Quick reference algorithm

Geriatric Trauma Algorithm

Trauma patients aged ≥ 65 · March 2026 edition

Geriatric shock: SBP < 110 mmHg or HR > 90 bpmRockwood CFS within 24 h of admission

Geriatric trauma patient — age ≥ 65

Geriatric-specific thresholds and frailty-based management

Geriatric shock?SBP < 110 mmHg OR HR > 90 bpm

Yes — shock

Upgrade activation

One tier higher

Consider occult shock

No shock

Standard activation

Per mechanism criteria

Both → ATLS + coagulation labs

ATLS + POC INR + anti-Xa level

Early coagulation assessment — geriatric patients frequently anticoagulated

Head strike OR anticoagulated?

YesMandatory CT head ↓NoStandard workup ↓

Yes

Head strike or anticoagulated

Mandatory CT head

Low threshold for imaging in geriatric population

ICH on CT?

Yes — ICH

Immediate reversal

Per reversal table

Target: 60 min

No ICH

Standard TBI

Management per BIG classification

No head strike, not anticoagulated

Standard workup

Per injury pattern

All paths → Frailty assessment

Frailty assessment — Rockwood CFS

Complete within 24 hours of admission

CFS score?

CFS 1–4Standard trauma management

Full resuscitation
Standard surgical indications

CFS 5–6Modified approach

Lower ICU threshold
Delirium prevention protocol
PT/OT consult day 1
Social work screen

CFS 7–8Conservative bias

Early goals of care discussion
Palliative care consult
Conservative treatment bias

CFS 9Comfort-focused

Comfort-focused care
Goals of care discussion with family

All CFS tiers → rib fracture check

Rib fractures?

Yes — rib fractures

CWITS-25-IS + Geriatric Modifier

Score 4+ → consider ICU
Score 7+ → consider SSRF
Regional anesthesia within 12 h

No rib fractures

Disposition per injury

Standard severity-based disposition criteria

Both → all geriatric patients

All geriatric patients

Reassess q12h
CAM-ICU for delirium
Fall risk assessment
Med reconciliation
Early mobilization
Nutrition screening