Predicting In-Hospital and 1-Year Mortality in Geriatric Trauma Patients Using Geriatric Trauma Outcome Score

Ahl, Rebecka; Phelan, Herbert; Doğan, Sinan; Cao, Yang; Cook, Albert S.; Mohseni, Shahin

doi:10.1016/j.jamcollsurg.2016.12.011

Cited by 31 publications

(26 citation statements)

References 16 publications

(17 reference statements)

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“…It had been reported that the accuracy of GTOS in predicting in-hospital survival was lower than that of TRISS [ 10 ]. In addition, with a misclassification rate of 17.6% and Brier score of 0.13, the GTOS is not adept at predicting 1-year mortality [ 11 ]. This result does not support the use of GTOS in place of the TRISS in predicting the mortality of elderly trauma patients [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, with a misclassification rate of 17.6% and Brier score of 0.13, the GTOS is not adept at predicting 1-year mortality [ 11 ]. This result does not support the use of GTOS in place of the TRISS in predicting the mortality of elderly trauma patients [ 11 ]. Notably, blood transfusion (BT) is reported to be associated with increased morbidity and mortality [ 12 ], and massive blood transfusion is associated with a variety of complications such as coagulation abnormalities, immunosuppression, hypothermia, lung injury, and infection [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Rau

Kuo

et al. 2018

IJERPH

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Background: For elderly trauma patients, a prognostic tool called the Geriatric Trauma Outcome Score (GTOS), where GTOS = (age) + (ISS × 2.5) + (22 if any packed red blood cells (pRBCs) were transfused within 24 h after admission), was developed for predicting mortality. In such calculation, a score of 22 was added in the calculation of GTOS regardless of the transfused units of blood. This study aimed to assess the effect of transfused blood units on the mortality outcomes of the elderly trauma patients who received blood transfusion (BT). Methods: Detailed data of 687 elderly trauma patients aged ≥65 years who were transfused with pRBCs within 24 h after admission into a level I trauma center between 1 January 2009 and 31 December 2016 were retrieved from the Trauma Registry System database. Based on the units of pRBCs transfused, the study population was divided into two groups to compare the mortality outcomes between these groups. Adjusted odds ratios (AORs) with its 95% confidence intervals (CIs) for mortality were calculated by adjusting sex, pre-existing comorbidities, and GTOS. Results: When the cut-off value of BT was set as 3 U of pRBCs, patients who received BT ≥ 3 U had higher odds of mortality than those who received BT < 3 U (OR, 3.0; 95% CI, 1.94–4.56; p < 0.001). Patients who received more units of pRBCs still showed higher odds of mortality than their counterparts. After adjusting for sex, pre-existing comorbidities, and GTOS, comparison revealed that the patients who received BT of 3 U to 6 U had a 1.7-fold adjusted odds of mortality than their counterparts. The patients who received BT ≥ 8 U and 10 U had a 2.1-fold (AOR, 2.1; 95% CI, 1.09–3.96; p < 0.001) and 4.4-fold (AOR, 4.4; 95% CI, 2.04–9.48; p < 0.001) adjusted odds of mortality than those who received BT < 8 U and <10 U, respectively. Conclusions: This study revealed that the units of BT did matter in determining the probability of mortality. For those who received more units of blood, the mortality may be underestimated according to the GTOS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Rau

Kuo

et al. 2018

IJERPH

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“…Its performance is even better when patients with care restrictions are excluded. However, it has a poor ability to predict 1-year mortality[59]. …”

Section: Can We Predict Outcome?mentioning

confidence: 99%

Severe trauma in the geriatric population

Llompart‐Pou¹,

Pérez-Bárcena²,

Chico‐Fernández³

et al. 2017

WJCCM

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Geriatric trauma constitutes an increasingly recognized problem. Aging results in a progressive decline in cellular function which leads to a loose of their capacity to respond to injury. Some medications commonly used in this population can mask or blunt the response to injury. Falls constitute the most common cause of trauma and the leading cause of trauma-related deaths in this population. Falls are complicated by the widespread use of antiplatelets and anticoagulants, especially in patients with brain injury. Under-triage is common in this population. Evaluation of frailty could be helpful to solve this issue. Appropriate triaging and early aggressive management with correction of coagulopathy can improve outcome. Limitation of care and palliative measures must be considered in cases with a clear likelihood of poor prognosis.

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“…Furthermore, geriatric trauma patients account for 36% of all ambulance transports, >25% of trauma hospitalizations, and 25%–30% of total trauma costs. These trauma patients experience higher morbidity and mortality than younger trauma patients . Many elderly patients have co‐morbidities, including hypertension (>50%), heart disease (>30%), and others, which may contribute to increased morbidity and mortality…”

Section: Introductionmentioning

confidence: 99%

Predictors of new‐onset atrial fibrillation in geriatric trauma patients

et al. 2020

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Introduction: Geriatric patients (age >65) comprise a growing segment of the trauma population. New-onset atrial fibrillation may occur after injury, complicating clinical management and resulting in significant morbidity and mortality. This study was undertaken to identify clinical and demographic factors associated with new-onset atrial fibrillation among geriatric trauma patients. Methods:In this case control study, eligible participants included admitted trauma patients age 65 and older who developed new-onset atrial fibrillation during the hospitalization. Controls were admitted trauma patients who were matched for age and injury severity score, who did not develop atrial fibrillation. We evaluated the associations between new-onset atrial fibrillation and clinical characteristics, including patient demographics, health behaviors, chronic medical conditions, and course of care.Results: Data were available for 63 cases and 25 controls. Patients who developed atrial fibrillation were more likely to be male, compared to controls (49% versus 24%; odds ratio 3.0[1.0, 8.9]). Other demographic and clinical factors were not associated with new-onset atrial fibrillation, including mechanism of injury, co-morbid medical conditions, drug or alcohol use, surgical procedures, and intravenous fluid administration. Conclusions:Male geriatric trauma patients were at higher risk for developing newonset atrial fibrillation. Other demographic and clinical factors were not associated with new-onset atrial fibrillation.

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Predicting In-Hospital and 1-Year Mortality in Geriatric Trauma Patients Using Geriatric Trauma Outcome Score

Cited by 31 publications

References 16 publications

Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Severe trauma in the geriatric population

Predictors of new‐onset atrial fibrillation in geriatric trauma patients

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