The GERtality Score: The Development of a Simple Tool to Help Predict in-Hospital Mortality in Geriatric Trauma Patients

Scherer, Julian; Kalbas, Yannik; Ziegenhain, Franziska; Neuhaus, Valentin; Lefering, Rolf; Teuben, Michel; Sprengel, Kai; Pape, Hans-Christian; Jensen, Kai Oliver

doi:10.3390/jcm10071362

Cited by 10 publications

(5 citation statements)

References 34 publications

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“…The FFI is associated with an increased risk of complications. This result is in accordance with previous studies on geriatric trauma patients and their complication predictions with the FFI [24,[36][37][38][39][40]. In the literature, the FFI has also been shown to be predictive of the development of pneumonia [41,42].…”

Section: Plos Onesupporting

confidence: 91%

Implementation of a novel nursing assessment tool in geriatric trauma patients with proximal femur fractures

Berk¹,

Thalmann²,

Jensen³

et al. 2023

PLoS ONE

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Background Geriatric trauma patients represent a special challenge in postoperative care and are prone to specific complications. The goal of this study was to analyse the predictive potential of a novel nursing assessment tool, the outcome-oriented nursing assessment for acute care (ePA-AC), in geriatric trauma patients with proximal femur fractures (PFF). Methods A retrospective cohort study of geriatric trauma patients aged ≥ 70 years with PFF was conducted at a level 1 trauma centre. The ePA-AC is a routinely used tool that evaluates pneumonia; confusion, delirium and dementia (CDD); decubitus (Braden Score); the risk of falls; the Fried Frailty index (FFI); and nutrition. Assessment of the novel tool included analysis of its ability to predict complications including delirium, pneumonia and decubitus. Results The novel ePA-AC tool was investigated in 71 geriatric trauma patients. In total, 49 patients (67.7%) developed at least one complication. The most common complication was delirium (n = 22, 44.9%). The group with complications (Group C) had a significantly higher FFI compared with the group without complications (Group NC) (1.7 ± 0.5 vs 1.2 ± 0.4, p = 0.002). Group C had a significantly higher risk score for malnutrition compared with Group NC (6.3 ± 3.4 vs 3.9 ± 2.8, p = 0.004). A higher FFI score increased the risk of developing complications (odds ratio [OR] 9.8, 95% confidence interval [CI] 2.0 to 47.7, p = 0.005). A higher CDD score increased the risk of developing delirium (OR 9.3, 95% CI 2.9 to 29.4, p < 0.001). Conclusion The FFI, CDD, and nutritional assessment tools are associated with the development of complications in geriatric trauma patients with PFF. These tools can support the identification of geriatric patients at risk and might guide individualised treatment strategies and preventive measures.

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Section: Plos Onesupporting

confidence: 91%

Implementation of a novel nursing assessment tool in geriatric trauma patients with proximal femur fractures

Berk¹,

Thalmann²,

Jensen³

et al. 2023

PLoS ONE

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“…Many studies have shown that a low GCS score is associated with poor prognosis in elderly patients with trauma, as shown in the present study. 33 , 34 However, it is difficult to predict prognosis with the GCS because it does not involve brainstem reflexes, nor does it accurately describe the verbal status of intubated patients. In particular, in elderly patients with trauma, the measurement of the GCS motor response can be inaccurate, requiring more careful measurement.…”

Section: Discussionmentioning

confidence: 99%

Association Between Platelet-to-Lymphocyte Ratio and In-hospital Mortality in Elderly Patients with Severe Trauma

Lee,

Lee

2024

WestJEM

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Introduction The platelet-to-lymphocyte ratio (PLR) is associated with the inflammatory response in various diseases. However, studies on the use of the PLR for the prognosis of elderly patients with severe trauma are lacking. In this study, we examined the relationship between the PLR and in-hospital mortality in elderly patients with severe trauma. Methods This retrospective observational study included elderly (≥65 years) patients who were admitted for severe trauma (as defined by an Injury Severity Score [ISS] ≥ 16) between January–December 2022. We conducted multivariate analysis to assess the association between the PLR and in-hospital mortality using logistic regression of relevant covariates. We also performed receiver operating characteristic curve analysis to examine the prognostic performance of the PLR for in-hospital mortality. Results Among the 222 patients included in the study, the in-hospital mortality rate was 19.4% (43). The PLR of non-survivors was lower than that of survivors (62.1 vs 124.5). The areas under the curve (AUC) of the Glasgow Coma Scale (GCS) score ≤12, ISS, hemoglobin level, and PLR for predicting in-hospital mortality were 0.730 (95% confidence interval [CI] 0.667–0.787), 0.771 (95% CI 0.710–0.824), 0.657 (95% CI 0.591–0.719), and 0.730 (95% CI 0.667–0.788), respectively. The AUC of the PLR was not significantly different from that of GCS score ≤12 and ISS for predicting in-hospital mortality. Multivariate analysis showed that the PLR was independently associated with in-hospital mortality (odds ratio: 0.993; 95% CI 0.987–0.999). Conclusion Low platelet-to-lymphocyte ratio is independently associated with in-hospital mortality in elderly patients with severe trauma.

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“…The new GERtality score seems to be an userfriendly and adequate in-hospital mortality prediction model for severely injured geriatric trauma patients, as it includes only five easily assessable patient variables, which makes it practical and simple to calculate. However, further studies should validate the novel GERtality score on different datasets [66].…”

Section: Summary Of Evidence and Discussionmentioning

confidence: 99%

The 2023 WSES guidelines on the management of trauma in elderly and frail patients

De Simone,

Chouillard,

Podda

et al. 2024

World J Emerg Surg

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Background The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. Methods Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. Results The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient’s directives, family feelings and representatives' desires, and all decisions should be shared. Conclusions The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes. Graphical abstract

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The GERtality Score: The Development of a Simple Tool to Help Predict in-Hospital Mortality in Geriatric Trauma Patients

Cited by 10 publications

References 34 publications

Implementation of a novel nursing assessment tool in geriatric trauma patients with proximal femur fractures

Implementation of a novel nursing assessment tool in geriatric trauma patients with proximal femur fractures

Association Between Platelet-to-Lymphocyte Ratio and In-hospital Mortality in Elderly Patients with Severe Trauma

The 2023 WSES guidelines on the management of trauma in elderly and frail patients

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