TY  - JOUR
PY  - 2017//
TI  - A comparison of prognosis calculators for geriatric trauma: A P.A.L.LI.A.T.E. consortium study
JO  - Journal of trauma and acute care surgery
A1  - Madni, Tarik D.
A1  - Ekeh, Akpofure Peter
A1  - Brakenridge, Scott C.
A1  - Brasel, Karen J.
A1  - Joseph, Bellal
A1  - Inaba, Kenji
A1  - Bruns, Brandon R.
A1  - Kerby, Jeffrey D.
A1  - Cuschieri, Joseph
A1  - Mohler, M. Jane
A1  - Nakonezny, Paul A.
A1  - Clark, Audra
A1  - Imran, Jonathan
A1  - Wolf, Steven E.
A1  - Paulk, M. Elizabeth
A1  - Rhodes, Ramona L.
A1  - Phelan, Herb A.
SP  - 90
EP  - 96
VL  - 83
IS  - 1
N2  - 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. <br><br>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). <br><br>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. <br><br>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.<p />  <p>Language: en</p>
LA  - en
SN  - 2163-0755
UR  - http://dx.doi.org/10.1097/TA.0000000000001506
ID  - ref1
ER  -