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 trend of trauma patients and to compare different scoring tools to predict in-hospital mortality in elderly trauma patients.Methods: National Trauma Database (NTDB) in the United States from 2005 to 2015 and the Trauma Register DGU® in German from 1994 to 2012 was searched to describe age change of trauma patients. Then we secondly analyzed the data published in http://datadryad.org/. 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 value of 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 predicting in-hospital mortality among geriatric trauma patients.Results:The analysis of NTDB showed the percentage of geriatric trauma has increased from 0.18 to 0.30, 2005-2015. The analysis of DGU showed the mean age rose from 39.11 in 1993 to 51.10 in 2013, and the percentage of patients aged ≥60 rose from 16.5% to 37.5%. A total of 311 patients aged more than 65 years were secondly analyzed. One hundred and sixty-four (52.73%) patients died in the hospital. ISS, NISS, APACHE, and SAPS in the death group were significantly higher than those in the survival group, but TRISS in the death group was significantly lower than those in the survival group. The AUC of APACHE Ⅱ was 0.715, ISS was 0.807, NISS was 0.850, SPAS Ⅱ was 0.725, and TRISS was 0.828.Conclusion:The increasing number of trauma in the elderly is a challenge for current and future trauma management. Compared with APACHE and SAPS, ISS, NISS and TRISS are more suitable for predicting in-hospital mortality in elderly trauma patients.