Citation

Ahl R, Phelan HA, Dogan S, Cao Y, Cook AC, Mohseni S. J. Am. Coll. Surg. 2016; 224(3): 264-269.

Affiliation

School of Medical Sciences, Orebro University, Orebro, Sweden; Karolinska University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, Stockholm, Sweden; Orebro University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, Orebro, Sweden. Electronic address: mohsenishahin@yahoo.com.

Copyright

(Copyright © 2016, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2016.12.011

PMID

28017806

Abstract

BACKGROUND: The Geriatric Trauma Outcome Score, GTOS (= [age] + [Injury Severity Score (ISS)x2.5] + 22 [if packed red blood cells (PRBC) transfused ≤24hrs of admission]), was developed and validated as a prognostic indicator for in-hospital mortality in elderly trauma patients. However, GTOS neither provides information regarding post-discharge outcomes, nor discriminates between patients dying with and without care restrictions. Isolating the latter, GTOS prediction performance was examined during admission and 1-year post-discharge in a mature European trauma registry. STUDY DESIGN: All trauma admissions ≥65years in a university hospital during 2007-2011 were considered. Data regarding age, ISS, PRBC transfusion ≤24hrs, therapy restrictions, discharge disposition and mortality were collected. In-hospital deaths with therapy restrictions and patients discharged to hospice were excluded. GTOS was the sole predictor in a logistic regression model estimating mortality probabilities. Performance of the model was assessed by misclassification rate, Brier score and area under the curve (AUC).

RESULTS: The study population was 1080 subjects with a median age of 75 years, mean ISS of 10 and PRBC transfused in 8.2%). In-hospital mortality was 14.9% and 7.7% after exclusions. Misclassification rate fell from 14% to 6.5%, Brier score from 0.09 to 0.05. AUC increased from 0.87 to 0.88. Equivalent values for the original GTOS sample were 9.8%, 0.07, and 0.87. One-year mortality follow-up showed a misclassification rate of 17.6%, and Brier score of 0.13.

CONCLUSIONS: Excluding patients with care restrictions and discharged to hospice improved GTOS performance for in-hospital mortality prediction. GTOS is not adept at predicting 1-year mortality.

Copyright © 2016. Published by Elsevier Inc.

Language: en