Citation

Cook AC, Joseph B, Inaba K, Nakonezny PA, Bruns BR, Kerby JD, Brasel KJ, Wolf SE, Cuschieri J, Paulk ME, Rhodes RL, Brakenridge SC, Phelan HA. J. Trauma Acute Care Surg. 2015; 80(2): 204-209.

Affiliation

UT Southwestern Department of Surgery; Dallas, TX allyson.cook@phhs.org University of Arizona Division of Trauma, Critical Care, Burn, and Emergency Surgery; Tucson, AZ bjoseph@surgery.arizona.edu USC Division of Acute Care Surgery and Surgical Critical Care; Los Angeles, CA Kenji.Inaba@med.usc.edu UT Southwestern Department of Clinical Sciences, Division of Biostatistics; Dallas, TX Paul.nakonezny@utsouthwestern.edu R Adams Cowley Shock Trauma Center at the University of Maryland; Baltimore, MD bbruns@umm.edu UAB Medical Center, Division of Trauma, Burns, and Surgical Critical Care; Birmingham, AL jkerby@uabmc.edu Oregon Health Sciences University; Div of Trauma, Critical Care, and Acute Care Surgery; Portland, OR brasel@ohsu.edu UT Southwestern Division of Burns/Trauma/Critical Care; Dallas, TX Steven.wolf@utsouthwestern.edu University of Washington Division of Trauma, Burn, and Critical Care Surgery; Seattle, WA jcuschie@uw.edu UT Southwestern Department of Internal Medicine, Palliative Medicine; Dallas, TX Elizabeth.paulk@utsouthwestern.edu UT Southwestern Division of Geriatrics, Palliative Medicine; Dallas, TX Ramona.rhodes@utsouthwestern.edu University of Florida Division of Acute Care Surgery; Gainesville, FL Scott.Brakenridge@surgery.ufl.edu UT Southwestern Division of Burns/Trauma/Critical Care; Dallas, TX herb.phelan@utsouthwestern.edu.

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000000926

PMID

26595708

Abstract

BACKGROUND: A prognostic tool for geriatric mortality after injury called the "Geriatric Trauma Outcome Score" (GTOS), where GTOS = [age] + [ISS x 2.5] + [22 if transfused any PRBCs by 24 hours after admission], was previously developed based on 13 years of data from geriatric trauma patients admitted to Parkland Hospital. We sought to validate the model.

METHODS: Four level I centers identified subjects ≥65 years for the period of the original study. The GTOS model was first specified using the formula [GTOS= age + (ISS x 2.5) + 22(if given PRBC by 24 hours)] developed from the Parkland sample, then used as the sole predictor in a logistic mixed model estimating probability of mortality in the validation sample, accounting for site as a random effect. We estimated the misclassification (error) rate, Brier score, Tjur R-square, and AUC in evaluating the predictive performance of the GTOS model.

RESULTS: The original Parkland sample (n=3,841) was mean age=76.6 years (SD±8.1); mean ISS=12.4 (SD±9.9); mortality=10.8%; and 11.9% received PRBCs at 24 hours. The validation sample (n=18,282) was mean age=77.0 years (SD+8.1); mean ISS=12.3 (SD+10.6); mortality=11.0%; and 14.1% received PRBCs at 24 hours. Fitting the GTOS model to the validation sample revealed that the parameter estimates from the validation sample were similar to those of fitting it to the Parkland sample with highly overlapping 95% confidence limits. The misclassification (error) rate for the GTOS logistic model applied to the validation sample was 9.97%, similar to that of the Parkland sample (9.79%). Brier score, Tjur R-square, and AUC for the GTOS logistic model when applied to the validation sample were 0.07, 0.25, and 0.86, respectively, compared with 0.08, 0.20, and 0.82, respectively, for the Parkland sample.

CONCLUSION: Utilizing data available at 24 hours post-injury, the GTOS accurately predicts in-hospital mortality for the injured elderly. LEVEL OF EVIDENCE: III STUDY TYPE: Prognostic.

Language: en