Citation

Ross SW, Adeyemi FM, Zhou M, Minhajuddin AT, Porembka MR, Cripps MW, Phelan HA. J. Trauma Acute Care Surg. 2019; ePub(ePub): ePub.

Affiliation

Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002441

PMID

31318764

Abstract

BACKGROUND: GTOS predicts in-patient mortality in geriatric trauma patients and has been validated in a prospective multicenter trial and expanded to predict adverse discharge (GTOS II). We hypothesized that these formulations actually underestimate the downstream sequelae of injury and sought to predict longer-term mortality in geriatric trauma patients.

METHODS: The Parkland Memorial Hospital Trauma registry was queried for patients age ≥65 years from 2001-2013. Patients were then matched to the SSDI. The primary outcome was one-year mortality. The original GTOS formula (variables of age, ISS, 24-hour transfusion) was tested to predict 1-year mortality using receiver operator curves. Significant variables on univariate analysis were used to build an optimal multivariate model to predict 1-year mortality (GTOS III).

RESULTS: There were 3,262 patients who met inclusion. Inpatient mortality was 10.0% (324) and increased each year: 15.8% one, 17.8% two, and 22.6% five years. The original GTOS equation had an area under the curve (AUC) of 0.742 for 1-year mortality. Univariate analysis showed that patients with 1-year mortality had on average increased age (75.7 vs. 79.5 years), ISS (11.1 vs. 19.1), lower GCS (14.3 vs. 10.5), more likely to require transfusion within 24 hours (11.5% vs. 31.3%), and adverse discharge (19.5% vs. 78.2%; p<0.0001 for all). Multivariate logistic regression was used to create the optimal equation to predict one-year mortality: [GTOSIII = Age + (0.806 x ISS) + 5.55 (if transfusion in first 24 hours) + 21.69 (if low GCS) + 34.36 (if adverse discharge)]; AUC of 0.878.

CONCLUSIONS: Traumatic injury in geriatric patients is associated with high mortality rates at 1-5 years. GTOS III has robust test characteristics to predict death at one year and can be used to guide patient centered goals discussions with objective data. STUDY TYPE: Original Article LEVEL OF EVIDENCE: III.

Language: en