2019 WTA PODIUM PAPERS

One-year mortality in geriatric trauma patients: Improving upon the geriatric trauma outcomes score utilizing the social security death index

Ross, Samuel W. MD, MPH; Adeyemi, Folarin M. BS; Zhou, Michael MD; Minhajuddin, Abu T. PhD; Porembka, Matthew R. MD; Cripps, Michael W. MD, MSCS; Phelan, Herbert A. MD, MSCS

Author Information

From the Division of Acute Care Surgery, Department of Surgery (S.W.R.), Carolinas Medical Center, Charlotte, North Carolina; Division of General and Acute Care Surgery, Department of Surgery (F.M.A., M.Z., A.T.M., M.W.C., H.A.P.), and Division of Surgical Oncology, Department of Surgery (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Texas.

Submitted: January 15, 2019, Revised: May 30, 2019, Accepted: June 16, 2019, Published online: July 10, 2019.

Presented at the 49th Annual Meeting of Western Trauma Association, March 4, 2019, in Snowmass, Colorado, Earl G. Young Clinical Research Competition Award Nomination Paper.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Herbert Phelan, MD, FACS, Division of General and Acute Care Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd. – Mail Code 9158, Dallas, TX 75390-9158; email: [email protected].

Journal of Trauma and Acute Care Surgery 87(5):p 1148-1155, November 2019. | DOI: 10.1097/TA.0000000000002441

Abstract

BACKGROUND 

Geriatric Trauma Outcomes Score (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 65 years or older from 2001 to 2013. Patients were then matched to the Social Security Death Index. The primary outcome was 1-year mortality. The original GTOS formula (variables of age, Injury Severity Score [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%, 1 year; 17.8%, 2 years; and 22.6%, 5 years. The original GTOS equation had an area under the curve of 0.742 for 1-year mortality. Univariate analysis showed that patients with 1-year mortality had on average increased age (75.7 years vs. 79.5 years), ISS (11.1 vs. 19.1), lower GCS score (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 1-year mortality: (GTOSIII = age + [0.806 × ISS] + 5.55 [if transfusion in first 24 hours] + 21.69 [if low GCS] + 34.36 [if adverse discharge]); area under the curve of 0.878.

CONCLUSION 

Traumatic injury in geriatric patients is associated with high mortality rates at 1 year to 5 years. GTOS III has robust test characteristics to predict death at 1 year and can be used to guide patient centered goals discussions with objective data.

LEVEL OF EVIDENCE 

Prognostic, level III.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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