Change in age distribution of the injuries and comparison of different scoring tools in predicting mortality among geriatric trauma patients

Abstract

Purpose: The aim of this study was to describe the age change tendency of trauma patients and to test the accuracy of different scoring tools in prediction of in-hospital mortality in case of geriatric trauma.Methods: Annual reports released by the National Trauma Database (NTDB) in the United States from 2005 to 2015 and the Trauma Register DGU® in German from 1994 to 2012 were used to describe the age change tendency of trauma patients. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level Ⅰ trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into survival group and non-survival group. Receiver Operating Characteristic Curve (ROC) analysis was used to evaluated the predictive performance of the ISS (injury severity score); NISS (new injury severity score), APACHE Ⅱ (Acute Physiology and Chronic Health Evaluation Ⅱ), SPAS Ⅱ (simplified acute physiology score Ⅱ) and TRISS (Trauma and Injury Severity Score) in prediction of in-hospital mortality among geriatric trauma patients. Results: The analysis of the NTDB showed the proportion of geriatric trauma increased from 18% to 30% from 2005 to 2015. The analysis of the DGU® showed the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥60 rose from 16.5% to 37.5%. The secondary analysis indicated one hundred and sixty-four (52.73%) patients died in the hospital. The ISS, NISS, APACHE Ⅱ, and SAPS Ⅱ in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUC of the ISS, NISS, TRISS, APACHE Ⅱ, and SAPS Ⅱ was 0.807, 0.850, 0.828, 0.715 and 0.725, respectively.Conclusion: The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the accuracy of the APACHE Ⅱ and SAPS Ⅱ to predict in-hospital mortality in case of geriatric trauma.