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A comparison of prognosis calculators for geriatric trauma: A Prognostic Assessment of Life and Limitations After Trauma in the Elderly consortium study

Madni, Tarik David MD; Ekeh, Akpofure Peter MD; Brakenridge, Scott C. MD; Brasel, Karen J. MD; Joseph, Bellal MD; Inaba, Kenji MD; Bruns, Brandon R. MD; Kerby, Jeffrey D. MD, PhD; Cuschieri, Joseph MD; Mohler, M. Jane PhD; Nakonezny, Paul A. PhD; Clark, Audra MD; Imran, Jonathan MD; Wolf, Steven E. MD; Paulk, M. Elizabeth MD; Rhodes, Ramona L. MD; Phelan, Herb A. III MD

Journal of Trauma and Acute Care Surgery: July 2017 - Volume 83 - Issue 1 - p 90–96
doi: 10.1097/TA.0000000000001506
EAST Plenary Paper

BACKGROUND The nine-center Prognostic Assessment of Life and Limitations After Trauma in the Elderly consortium has validated the Geriatric Trauma Outcome Score (GTOS) as a prognosis calculator for injured elders. We compared GTOS' performance to that of the Trauma Injury Severity Score (TRISS) in a multicenter sample.

METHODS Three Prognostic Assessment of Life and Limitations After Trauma in the Elderly centers not submitting subjects to the GTOS validation study identified subjects aged 65 years to 102 years admitted from 2000 to 2013. GTOS was specified using the formula [GTOS = age + (Injury Severity Score [ISS] × 2.5) + 22 (if transfused packed red cells (PRC) at 24 hours)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 years = 0 and ≥55 years = 1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISSP = −2.5355 + (0.9934 × RTS) + (−0.0651 × ISS) + (−1.1360 × Age)]. TRISS Blunt was specified as [TRISSB = −0.4499 + (0.8085 × RTS Total) + (−0.0835 × ISS) + (−1.7430 × Age)]. Each then became the sole predictor in a separate logistic regression model to estimate probability of mortality. Model performances were evaluated using misclassification rate, Brier score, and area under the curve.

RESULTS Demographics (mean + SD) of subjects with complete data (N = 10,894) were age, 78.3 years ± 8.1 years; ISS, 10.9 ± 8.4; RTS = 7.5 ± 1.1; mortality = 6.9%; blunt mechanism = 98.6%; 3.1 % of subjects received PRCs. The penetrating trauma subsample (n = 150) had a higher mortality rate of 20.0%. The misclassification rates for the models were GTOS, 0.065; TRISSB, 0.051; and TRISSP, 0.120. Brier scores were GTOS, 0.052; TRISSB, 0.041; and TRISSP, 0.084. The area under the curves were GTOS, 0.844; TRISSB, 0.889; and TRISSP, 0.897.

CONCLUSION GTOS and TRISS function similarly and accurately in predicting probability of death for injured elders. GTOS has the advantages of a single formula, fewer variables, and no reliance on data collected in the emergency room or by other observers.

LEVEL OF EVIDENCE Prognostic, level II.

From the Department of Surgery (T.D.M.), University of Texas-Southwestern Medical Center, Dallas, Texas; Wright State Physicians, Division of Acute Care Surgery (A.P.E.), Dayton, Ohio; Division of Acute Care Surgery (S.C.B.), University of Florida, Gainesville, Florida; Division of Trauma, Critical Care, and Acute Care Surgery (K.J.B.), Oregon Health Sciences University, Portland, Oregon; Division of Trauma (B.J.), Critical Care, Burn, and Emergency Surgery, University of Arizona, Tucson, Arizona; Division of Acute Care Surgery and Surgical Critical Care (K.I.), University of Southern California, Los Angeles, California; R Adams Cowley Shock Trauma Center at the University of Maryland (B.R.B.), Baltimore, Maryland; Division of Trauma, Burns, and Surgical Critical Care (J.D.K.), UAB Medical Center, Birmingham, Alabama; Division of Trauma, Burn, and Critical Care Surgery (J.C.), University of Washington, Seattle, Washington; Department of Medicine (M.J.M.), University of Arizona, Tucson, Arizona; Division of Biostatistics, Department of Clinical Sciences (P.A.N.), Department of Surgery (A.C., J.I.), Division of Burns/Trauma/Critical Care (S.E.W., H.A.P.), Department of Internal Medicine (M.E.P.), Palliative Medicine, Division of Geriatrics (R.L.R.), Palliative Medicine, University of Texas-Southwestern Medical Center, Dallas, Texas.

Submitted: December 2, 2016, Revised: January 24, 2017, Accepted: February 13, 2017, Published online: April 18, 2017.

This original work will be presented from the podium at the 2017 annual meeting of EAST and has not been submitted or published elsewhere.

Address for reprints: Herb A. Phelan, MD, Division of Burns/Trauma/Critical Care, University of Texas-Southwestern Medical Center, Parkland Memorial Hospital, 5323 Harry Hines Blvd., E5.508A, Dallas, TX 75390-9158; email:

© 2017 Lippincott Williams & Wilkins, Inc.