Citation

Madni TD, Ekeh AP, Brakenridge SC, Brasel KJ, Joseph B, Inaba K, Bruns BR, Kerby JD, Cuschieri J, Mohler MJ, Nakonezny PA, Clark A, Imran J, Wolf SE, Paulk ME, Rhodes RL, Phelan HA. J. Trauma Acute Care Surg. 2017; 83(1): 90-96.

Affiliation

UT Southwestern Department of Surgery; Dallas, TX Wright State Physicians; Division of Acute Care Surgery; Dayton, OH University of Florida Division of Acute Care Surgery; Gainesville, FL Oregon Health Sciences University; Div of Trauma, Critical Care, and Acute Care Surgery; Portland, OR University of Arizona Division of Trauma, Critical Care, Burn, and Emergency Surgery; Tucson, AZ USC Division of Acute Care Surgery and Surgical Critical Care; Los Angeles, CA R Adams Cowley Shock Trauma Center at the University of Maryland; Baltimore, MD UAB Medical Center, Division of Trauma, Burns, and Surgical Critical Care; Birmingham, AL University of Washington Division of Trauma, Burn, and Critical Care Surgery; Seattle, WA University of Arizona, Department of Medicine UT Southwestern Department of Clinical Sciences, Division of Biostatistics; Dallas, TX UT Southwestern Department of Surgery; Dallas, TX UT Southwestern Department of Surgery; Dallas, TX UT Southwestern Division of Burns/Trauma/Critical Care; Dallas, TX UT Southwestern Department of Internal Medicine, Palliative Medicine; Dallas, TX UT Southwestern Division of Geriatrics, Palliative Medicine; Dallas, TX UT Southwestern Division of Burns/Trauma/Critical Care; Dallas, TX.

Copyright

(Copyright © 2017, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001506

PMID

28422904

Abstract

BACKGROUND: The nine-center PALLIATE consortium has validated the Geriatric Trauma Outcome Score (GTOS) as a prognosis calculator for injured elders. We compared GTOS' performance to that of the Trauma Injury Severity Score (TRISS) in a multicenter sample.

METHODS: Three PALLIATE centers not submitting subjects to the GTOS validation study identified subjects aged 65 to 102 yrs admitted from 2000-2013. GTOS was specified using the formula [GTOS = age + (ISS x 2.5) + 22 (if transfused packed red cells (PRC) at 24 hrs)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 yrs=0 and ≥55 yrs=1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISSP = -2.5355 + (0.9934 x RTS) + (-0.0651 x ISS) + (-1.1360 x Age)]. TRISS Blunt was specified as [TRISSB = -0.4499 + (0.8085 x RTS Total) + (-0.0835 x ISS) + (-1.7430 x Age)]. Each then became the sole predictor in a separate logistic regression model to estimate probability of mortality. Model performances were evaluated using misclassification rate, Brier score, and Area Under the Curve (AUC).

RESULTS: Demographics (mean + SD) of subjects with complete data (N=10,894) were age=78.3 yrs±8.1; ISS=10.9±8.4; RTS=7.5±1.1; mortality=6.9%; blunt mechanism=98.6%; 3.1 % of subjects received PRCs. The penetrating trauma sub-sample (n=150) had a higher mortality rate of 20.0%. The misclassification rates for the models were GTOS=0.065, TRISSB=0.051, and TRISSP=0.120. Brier scores were GTOS=0.052, TRISSB=0.041, and TRISSP=0.084. The AUCs were GTOS=0.844, TRISSB=0.889, and TRISSP=0.897.

CONCLUSIONS: GTOS and TRISS function similarly and accurately in predicting probability of death for injured elders. GTOS has the advantages of a single formula, fewer variables, and no reliance on data collected in the Emergency Room or by other observers. LEVEL OF EVIDENCE: Level II, prognostic.

Language: en