TY  - JOUR
PY  - 2021//
TI  - Validation of the artificial intelligence-based trauma outcomes predictor (TOP) in patients 65 years and older
JO  - Surgery
A1  - El Hechi, Majed
A1  - Gebran, Anthony
A1  - Bouardi, Hamza Tazi
A1  - Maurer, Lydia R.
A1  - El Moheb, Mohamad
A1  - Zhuo, Daisy
A1  - Dunn, Jack
A1  - Bertsimas, Dimitris
A1  - Velmahos, George C.
A1  - Kaafarani, Haytham M. A.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - BACKGROUND: The Trauma Outcomes Predictor tool was recently derived using a machine learning methodology called optimal classification trees and validated for prediction of outcomes in trauma patients. The Trauma Outcomes Predictor is available as an interactive smartphone application. In this study, we sought to assess the performance of the Trauma Outcomes Predictor in the elderly trauma patient. <br><br>METHODS: All patients aged 65 years and older in the American College of Surgeons-Trauma Quality Improvement Program 2017 database were included. The performance of the Trauma Outcomes Predictor in predicting in-hospital mortality and combined and specific morbidity based on incidence of 9 specific in-hospital complications was assessed using the c-statistic methodology, with planned subanalyses for patients 65 to 74, 75 to 84, and 85+ years. <br><br>RESULTS: A total of 260,505 patients were included. Median age was 77 (71-84) years, 57% were women, and 98.8% had a blunt mechanism of injury. The Trauma Outcomes Predictor accurately predicted mortality in all patients, with excellent performance for penetrating trauma (c-statistic: 0.92) and good performance for blunt trauma (c-statistic: 0.83). Its best performance was in patients 65 to 74 years (c-statistic: blunt 0.86, penetrating 0.93). Among blunt trauma patients, the Trauma Outcomes Predictor had the best discrimination for predicting acute respiratory distress syndrome (c-statistic 0.75) and cardiac arrest requiring cardiopulmonary resuscitation (c-statistic 0.75). Among penetrating trauma patients, the Trauma Outcomes Predictor had the best discrimination for deep and organ space surgical site infections (c-statistics 0.95 and 0.84, respectively). <br><br>CONCLUSION: The Trauma Outcomes Predictor is a novel, interpretable, and highly accurate predictor of in-hospital mortality in the elderly trauma patient up to age 85 years. The Trauma Outcomes Predictor could prove useful for bedside counseling of elderly patients and their families and for benchmarking the quality of geriatric trauma care.<p />  <p>Language: en</p>
LA  - en
SN  - 0039-6060
UR  - http://dx.doi.org/10.1016/j.surg.2021.11.016
ID  - ref1
ER  -