@article{ref1,
title="Predicting in-hospital and 1-year mortality in geriatric trauma patients using Geriatric Trauma Outcome Score",
journal="Journal of the American Academy of Surgeons",
year="2016",
author="Ahl, Rebecka and Phelan, Herb A. and Dogan, Sinan and Cao, Yang and Cook, Allyson C. and Mohseni, Shahin",
volume="224",
number="3",
pages="264-269",
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). <br><br>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. <br><br>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.<br><br>Copyright © 2016. Published by Elsevier Inc.<p /> <p>Language: en</p>",
language="en",
issn="1072-7515",
doi="10.1016/j.jamcollsurg.2016.12.011",
url="http://dx.doi.org/10.1016/j.jamcollsurg.2016.12.011"
}