Predicting Mortality of Korean Geriatric Trauma Patients: A Comparison between Geriatric Trauma Outcome Score and Trauma and Injury Severity Score
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Purpose: The Geriatric Trauma Outcome Score (GTOS) is a new prognostic tool used to predict mortality of geriatric trauma patients. We aimed to apply this model to Korean geriatric trauma patients and compare it with the Trauma and Injury Severity Score (TRISS) method. Materials and Methods: Patients aged ≥65 years who were admitted to a level 1 trauma center from 2014 to 2018 were included in this study. Data on age, Injury Severity Score (ISS), packed red blood cell transfusion within 24 h, TRISS, admission disposition, mortality, and discharge disposition were collected. We analyzed the validity of GTOS and TRISS by comparing the area under the survival curve. Subgroup analysis for age, admission disposition, and ISS was performed. Results: Among 2586 participants, the median age was 75 years (interquartile range: 70–81). The median ISS was 9 (interquartile range: 4–12), with a transfusion rate (within 24 h) of 15.9% and mortality rate of 6.1%. The areas under the curve (AUCs) were 0.832 [95% confidence interval (CI), 0.817–0.846] and 0.800 (95% CI, 0.784–0.815) for GTOS and TRISS, respectively. On subgroup analysis, patients with ISS ≥9 showed a higher AUC of GTOS compared to the AUC of TRISS (p<0.05). Other subgroup analyses showed equally good power of discrimination for mortality. Conclusion: GTOS can be used to predict mortality of severely injured Korean geriatric patients, and also be helpful in deciding whether invasive or aggressive treatments should be administered to them.
Abstract
Purpose: The Geriatric Trauma Outcome Score (GTOS) is a new prognostic tool used to predict mortality of geriatric trauma patients. We aimed to apply this model to Korean geriatric trauma patients and compare it with the Trauma and Injury Severity Score (TRISS) method. Materials and Methods: Patients aged ≥65 years who were admitted to a level 1 trauma center from 2014 to 2018 were included in this study. Data on age, Injury Severity Score (ISS), packed red blood cell transfusion within 24 h, TRISS, admission disposition, mortality, and discharge disposition were collected. We analyzed the validity of GTOS and TRISS by comparing the area under the survival curve. Subgroup analysis for age, admission disposition, and ISS was performed. Results: Among 2586 participants, the median age was 75 years (interquartile range: 70–81). The median ISS was 9 (interquartile range: 4–12), with a transfusion rate (within 24 h) of 15.9% and mortality rate of 6.1%. The areas under the curve (AUCs) were 0.832 [95% confidence interval (CI), 0.817–0.846] and 0.800 (95% CI, 0.784–0.815) for GTOS and TRISS, respectively. On subgroup analysis, patients with ISS ≥9 showed a higher AUC of GTOS compared to the AUC of TRISS (p<0.05). Other subgroup analyses showed equally good power of discrimination for mortality. Conclusion: GTOS can be used to predict mortality of severely injured Korean geriatric patients, and also be helpful in deciding whether invasive or aggressive treatments should be administered to them.
참고문헌 (20)
- "National trauma data bank 2014 annual report"[URL]
- "Cause of death 2019 annual report"[URL]
- McGwin G Jr, "Preexisting conditions and mortality in older trauma patients", J Trauma, 56, pp.1291~1296 (2004)
- Goodmanson NW, "Defining geriatric trauma : when does age make a difference?", Surgery, 152, pp.668~674 (2012)
- Demetriades D, "Old age as a criterion for trauma team activation", J Trauma, 51, pp.754~756 (2001)
- Calland JF, "Evaluation and management of geriatric trauma : an Eastern Association for the Surgery of Trauma practice management guideline", J Trauma Acute Care Surg, 73, pp.S345~S350 (2012)[DOI]
- Zhao FZ, "Estimating geriatric mortality after injury using age, injury severity, and performance of a transfusion : the geriatric trauma outcome score", J Palliat Med, 18, pp.677~681 (2015)
- Champion HR, "A new characterization of injury severity", J Trauma, 30, pp.539~545 (1990)
- Joseph B, "Validating trauma-specific frailty index for geriatric trauma patients : a prospective analysis", J Am Coll Surg, 219, pp.10~17 (2014)[DOI]
- Cook AC, "Multicenter external validation of the geriatric trauma outcome score : a study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly(PALLIATE)consortium", J Trauma Acute Care Surg, 80, pp.204~209 (2016)
- Ahl R, "Predicting in-hospital and 1-year mortality in geriatric trauma patients using geriatric trauma outcome score", J Am Coll Surg, 224, pp.264~269 (2016)
- 류호완, "중증 노인 외상에서 사망 예측을 위한 손상 점수 체계 간의 비교", 대한응급의학회지, 31(6), pp.543~552 (2020), 대한응급의학회
- DeLong ER, "Comparing the areas under two or more correlated receiver operating characteristic curves : a nonparametric approach", Biometrics, 44, pp.837~845 (1988)
- Hannan EL, "Elderly trauma inpatients in New York state : 1994-1998", J Trauma, 56, pp.1297~1304 (2004)
- Copes WS, "The injury severity score revisited", J Trauma, 28, pp.69~77 (1988)
- Barea-Mendoza JA, "Predicting survival in geriatric trauma patients: a comparison between the TRISS methodology and the geriatric trauma outcome score", Cir Esp (Engl Ed), 96, pp.357~362 (2018)
- Schmid CH, "Multivariate classification rules: calibration and discrimination" (2014), John Wiley & Sons, Ltd.
- Tjur T, "Coefficients of determination in logistic regression models—A new proposal : the coefficient of discrimination", Am Stat, 63, pp.366~372 (2009)
- Brier GW, "Verification of forecasts expressed in terms of probability", Mon Weather Rev, 78, pp.1~3 (1950)
- Duvall DB, "Injury severity and comorbidities alone do not predict futility of care after geriatric trauma", J Palliat Med, 18, pp.246~250 (2015)