TY  - JOUR
PY  - 2019//
TI  - A comparison of scoring systems for predicting short- and long-term survival after trauma in older adults
JO  - Academic emergency medicine
A1  - Meagher, Ashley D.
A1  - Lin, Amber
A1  - Mandell, Samuel P.
A1  - Bulger, Eileen
A1  - Newgard, Craig
SP  - 621
EP  - 630
VL  - 26
IS  - 6
N2  - OBJECTIVES: Early identification of geriatric patients at high risk for mortality is important to guide clinical care, medical decision-making, palliative discussions, quality assurance, and research. We sought to identify injured older adults at highest risk for 30-day mortality using an empirically derived scoring system from available data, and to compare it with current prognostic scoring systems. <br><br>METHODS: This was a retrospective cohort study of injured adults ≥ 65 years transported by 44 emergency medical services (EMS) agencies to 49 emergency departments in Oregon and Washington from 1/1/2011 through 12/31/2011, with follow-up through 12/31/2012. We matched data from EMS, to Medicare, inpatient, trauma registries, and vital statistics. Using a primary outcome of 30-day mortality, we empirically derived a new risk score using binary recursive partitioning and compared it to the Charlson comorbidity index (CCI); modified frailty index (MFI); geriatric trauma outcome score (GTOS); GTOS II; and injury severity score (ISS). <br><br>RESULTS: There were 4,849 patients, of whom 234 (4.8%) died within 30 days and 1,040 (21.5%) died within 1 year. The derived score, the Geriatric Trauma Risk Indicator (GTRI) (emergent airway or CCI ≥2), had 87.2% sensitivity (95% CI 83.0-91.5%) and 30.6%% specificity (95% CI 29.3-31.9%) for 30-day mortality (AUROC 0.589, 95% CI: 0.566-0.611). AUROC values for other scoring systems ranged from 0.592 to 0.678. When the sensitivity for each existing score was held at 90%, specificity values ranged from 7.5% (ISS) to 30.6% (GTRI). <br><br>CONCLUSIONS: Older, injured, adults transported by EMS to a large variety of trauma and non-trauma hospitals were more likely to die within 30 days if they required emergent airway management or have a higher comorbidity burden. When compared to other risk measures and holding sensitivity constant near 90%, the GTRI had higher specificity, despite a lower AUROC. Using GTOS II or the GTRI may better identify high-risk older adults than traditional scores, such as ISS, but identification of an ideal prognostic tool remains elusive. This article is protected by copyright. All rights reserved.<br><br>This article is protected by copyright. All rights reserved.<p />  <p>Language: en</p>
LA  - en
SN  - 1069-6563
UR  - http://dx.doi.org/10.1111/acem.13727
ID  - ref1
ER  -