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

Feasible and predictive scoring systems for severely injured geriatric patients are lacking. Therefore, the aim of this study was to develop a scoring system for the prediction of in-hospital mortality in severely injured geriatric trauma patients. The TraumaRegister DGU® (TR-DGU) was utilized. European geriatric patients (≥65 years) admitted between 2008 and 2017 were included. Relevant patient variables were implemented in the GERtality score. By conducting a receiver operating characteristic (ROC) analysis, a comparison with the Geriatric Trauma Outcome Score (GTOS) and the Revised Injury Severity Classification II (RISC-II) Score was performed. A total of 58,055 geriatric trauma patients (mean age: 77 years) were included. Univariable analysis led to the following variables: age ≥ 80 years, need for packed red blood cells (PRBC) transfusion prior to intensive care unit (ICU), American Society of Anesthesiologists (ASA) score ≥ 3, Glasgow Coma Scale (GCS) ≤ 13, Abbreviated Injury Scale (AIS) in any body region ≥ 4. The maximum GERtality score was 5 points. A mortality rate of 72.4% was calculated in patients with the maximum GERtality score. Mortality rates of 65.1 and 47.5% were encountered in patients with GERtality scores of 4 and 3 points, respectively. The area under the curve (AUC) of the novel GERtality score was 0.803 (GTOS: 0.784; RISC-II: 0.879). The novel GERtality score is a simple and feasible score that enables an adequate prediction of the probability of mortality in polytraumatized geriatric patients by using only five specific parameters.

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Location of Injury and Other Factors Associated With Increased Survival Among Severely Injured Geriatric Trauma Patients

The American Surgeon ◽

10.1177/00031348211050578 ◽

2021 ◽

pp. 000313482110505

Author(s):

Paige C. Newman ◽

Tawnya M. Vernon ◽

Kellie E. Bresz ◽

Jennifer A. T. Schwartz

Keyword(s):

Geriatric Patients ◽

Injury Severity ◽

Geriatric Trauma ◽

Trauma Patients ◽

Severely Injured ◽

Retrospective Case ◽

Benzodiazepine Use ◽

Trauma Outcome ◽

Trauma Injury ◽

Trauma Activation

Background Patients with a Trauma Injury Severity Score (TRISS) < .5 are termed “unexpected survivors.” There is scarce information published on this subset of geriatric patients whose survival is an anomaly. Methods This is a retrospective case-control study examining all geriatric patients (age ≥65) not expected to survive (TRISS<.5) in the Pennsylvania Trauma Outcome Study (PTOS) database from 2013 to 2017. Primary outcome was survival to discharge. We selected 10 clinically important variables for logistic regression analysis as possible factors that may improve survival. Results 1336 patients were included, 395 (29.6%) were unexpected survivors. Factors that improved survival odds are the following: Place of injury: street/highway (AOR:0.51; 95% CI: .36-.73, P < .001) and residential institution (AOR:0.46; 95% CI: .21-.98, P = .043); and presence of Benzodiazepines (AOR:0.49; 95% CI: .31-.77, P = .002) or ethanol (AOR:0.57; 95% CI: .34-.97, P = .040). Factors that decreased survival odds are the following: Hypotension (AOR: 8.59; 95% CI: 4.33-17.01, P < .001) and hypothermia (AOR: 1.58; 95% CI: 1.10-2.28, P = .014). Gender, race/ethnicity, blood transfusion in first 24 hours, shift of presentation to Emergency Department, place of injury (farm, industrial, recreational, or public building), use of Tetrahydrocannabinol, amphetamines or opioids, and level of trauma activation did not impact survival. Discussion Location of injury (street/highway and residential institution) and ethanol or benzodiazepine use led to a significant increased survival in severely injured geriatric patients. Hypotension and hypothermia led to decreased survival. Future studies should determine possible reasons these factors lead to survival (and identify additional factors) to focus efforts in these areas to improve outcomes in geriatric trauma.

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Change in Age Distribution of the Injuries and Comparison of Different Scoring Tools in Predicting Mortality Among Geriatric Trauma Patients

10.21203/rs.3.rs-52207/v1 ◽

2020 ◽

Author(s):

Libing Jiang ◽

Zhongjun Zheng ◽

Mao Zhang

Keyword(s):

Hospital Mortality ◽

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Geriatric Trauma ◽

Trauma Patients ◽

Survival Group ◽

Elderly Trauma Patients ◽

Scoring Tools ◽

Death Group

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.

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Failure to Rescue in Geriatric Trauma: The Impact of Any Complication Increases with Age and Injury Severity in Elderly Trauma Patients

The American Surgeon ◽

10.1177/00031348211054072 ◽

2021 ◽

pp. 000313482110540

Author(s):

David P. Stonko ◽

Eric W. Etchill ◽

Katherine A. Giuliano ◽

Sandra R. DiBrito ◽

Daniel Eisenson ◽

...

Keyword(s):

Geriatric Patients ◽

Injury Severity ◽

Data Bank ◽

Geriatric Trauma ◽

Trauma Patients ◽

Failure To Rescue ◽

Elderly Trauma Patients ◽

Injured Patients ◽

The Impact ◽

Overall Mortality

Introduction The interaction of increasing age, Injury Severity Score (ISS), and complications is not well described in geriatric trauma patients. We hypothesized that failure to rescue rate from any complication worsens with age and injury severity. Methods The National Trauma Data Bank (NTDB) was queried for injured patients aged 65 years or older from January 1, 2013 through December 31, 2016. Demographics and injury characteristics were used to compare groups. Mortality rates were calculated across subgroups of age and ISS, and captured with heatmaps. Multivariable logistic regression was performed to identify independent predictors of mortality. Results 614,496 geriatric trauma patients were included; 151,880 (24.7%) experienced a complication. Those with complications tended to be older, female, non-white, have non-blunt mechanism, higher ISS, and hypotension on arrival. Overall mortality was highest (19%) in the oldest (≥86 years old) and most severely injured (ISS ≥ 25) patients, with constant age increasing across each ISS group was associated with a 157% increase in overall mortality ( P < .001, 95% CI: 148-167%). Holding ISS stable, increasing age group was associated with a 48% increase in overall mortality ( P < .001, 95% CI: 44-52%). After controlling for standard demographic variables at presentation, the existence of any complication was an independent predictor of overall mortality in geriatric patients (OR: 2.3; 95% CI: 2.2-2.4). Conclusions Any complication was an independent risk factor for mortality, and scaled with increasing age and ISS in geriatric patients. Differences in failure to rescue between populations may reflect critical differences in physiologic vulnerability that could represent targets for interventions.

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The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients

World Journal of Emergency Surgery ◽

10.1186/s13017-020-00340-1 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Libing Jiang ◽

Zhongjun Zheng ◽

Mao Zhang

Keyword(s):

Hospital Mortality ◽

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Apache Ii ◽

Geriatric Trauma ◽

Trauma Patients ◽

Survival Group ◽

Saps Ii ◽

Scoring Tools

Abstract Purpose The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients. Methods Annual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. 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 the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated. Results The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (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 AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 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 APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.

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A Comprehensive Investigation of Comorbidities, Mechanisms, Injury Patterns, and Outcomes in Geriatric Blunt Trauma Patients

The American Surgeon ◽

10.1177/000313481608201119 ◽

2016 ◽

Vol 82 (11) ◽

pp. 1055-1062 ◽

Cited By ~ 22

Author(s):

Carlos V. R. Brown ◽

Kevin Rix ◽

Amanda L. Klein ◽

Brent Ford ◽

Pedro G. R. Teixeira ◽

...

Keyword(s):

Injury Severity Score ◽

Blunt Trauma ◽

Severity Score ◽

Geriatric Patients ◽

Injury Severity ◽

Older Age ◽

Geriatric Trauma ◽

Trauma Patients ◽

Injury Patterns ◽

Abbreviated Injury Scale

The geriatric population is growing and trauma providers are often tasked with caring for injuries in the elderly. There is limited information regarding injury patterns in geriatric trauma patients stratified by mechanism of injury. This study intends to investigate the comorbidities, mechanisms, injury patterns, and outcomes in geriatric blunt trauma patients. A retrospective study of the 2012 National Trauma Databank was performed. Adult blunt trauma patients were identified; geriatric (>/=65) patients were compared with younger (<65) patients regarding admission demographics and vital signs, mechanism and severity of injury, and comorbidities. The primary outcome was injuries sustained and secondary outcomes included mortality, length of stay in the intensive care unit and hospital, and ventilator days. There were 589,830 blunt trauma patients who met the inclusion criteria, including 183,209 (31%) geriatric and 406,621 (69%) nongeriatric patients. Falls were more common in geriatric patients (79 vs 29%, P < 0.0001). Geriatric patients less often had an Injury Severity Score >/=16 (18 vs 20%, P < 0.0001) but more often a head Abbreviated Injury Scale >/=3 (24 vs 18%, P < 0.0001) and lower extremity Abbreviated Injury Scale >/=3 (24% vs 8%, P < 0.0001). After logistic regression older age was an independent risk factor for mortality for the overall population and across all mechanisms. Falls are the most common mechanism for geriatric trauma patients. Geriatric patients overall present with a lower Injury Severity Score, but more often sustain severe injuries to the head and lower extremities. Injury patterns vary significantly between older and younger patients when stratified by mechanism. Mortality is significantly higher for geriatric trauma patients and older age is independently associated with mortality across all mechanisms.

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Geriatric Trauma Mortality: Does Trauma Center Level Matter?

The American Surgeon ◽

10.1177/0003134820983190 ◽

2020 ◽

pp. 000313482098319

Author(s):

Frederick B. Rogers ◽

Madison E. Morgan ◽

Catherine Ting Brown ◽

Tawnya M. Vernon ◽

Kellie E. Bresz ◽

...

Keyword(s):

Geriatric Patients ◽

Injury Severity ◽

Data Bank ◽

Absolute Number ◽

Geriatric Trauma ◽

Multivariate Logistic Regression Model ◽

Trauma Patients ◽

Adjusted Analysis ◽

Level Ii ◽

Level I

Background Given their mostly rural/suburban locations, level II trauma centers (TCs) may offer greater exposure to and experience in managing geriatric trauma patients. We hypothesized that geriatric patients would have improved outcomes at level II TCs compared to level I TCs. Methods The Pennsylvania Trauma Outcome Study (PTOS) database was retrospectively queried from 2003 to 2017 for geriatric (age ≥65 years) trauma patients admitted to level I and II TCs in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in care between level I and II TCs. A multivariate logistic regression model assessed the adjusted impact of care at level I vs II TCs on mortality, complications, and functional status at discharge (FSD). The National Trauma Data Bank (NTDB) was retrospectively queried for geriatric (age ≥65 years) trauma admissions to state-accredited level I or level II TCs in 2013. Results 112 648 patients met inclusion criteria. The proportion of geriatric trauma patients across level I and level II TCs were determined to be 29.1% and 36.2% ( P <.001), respectively. In adjusted analysis, there was no difference in mortality (adjusted odds ratio [AOR]: 1.13; P = .375), complications (AOR: 1.25; P = .080) or FSD (AOR: 1.09; P = .493) when comparing level I to level II TCs. Adjusted analysis from the NTDB (n = 144 622) also found that mortality was not associated with TC level (AOR: 1.04; P = .182). Discussion Level I and level II TCs had similar rates of mortality, complications, and functional outcomes despite a higher proportion (but lower absolute number) of geriatric patients being admitted to level II TCs. Future consideration for location of centers of excellence in geriatric trauma should include both level I and II TCs.

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The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients

10.21203/rs.3.rs-52207/v3 ◽

2020 ◽

Author(s):

Libing Jiang ◽

Zhongjun Zheng ◽

Mao Zhang

Keyword(s):

Hospital Mortality ◽

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Secondary Analysis ◽

Geriatric Trauma ◽

Trauma Patients ◽

Survival Group ◽

Scoring Tools ◽

Death Group

Abstract Purpose: The study aimed to test the incidence of geriatric trauma is increasing and evaluate different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients.Methods: Part 1: Annual reports released by the National Trauma Database (NTDB) in the United States from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to test the incidence of geriatric trauma is increasing. Part 2: 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 the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE Ⅱ (Acute Physiology and Chronic Health Evaluation Ⅱ) and SPAS Ⅱ (simplified acute physiology score Ⅱ) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated.Results: Part 1: The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18% to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥60 years rose from 16.5% to 37.5%. Part 2: The findings from the secondary analysis showed that 164 (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 AUCs of the ISS, NISS, TRISS, APACHE Ⅱ, and SAPS Ⅱ for the prediction of in-hospital mortality in geriatric trauma patients were 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 APACHE Ⅱ and SAPS Ⅱ for the prediction of in-hospital mortality in geriatric trauma patients.

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The Effect of Older Blood on Mortality, Need for ICU Care, and the Length of ICU Stay after Major Trauma

The American Surgeon ◽

10.1177/000313480507100918 ◽

2005 ◽

Vol 71 (9) ◽

pp. 781-785 ◽

Cited By ~ 18

Author(s):

Zuri Murrell ◽

Jason S. Haukoos ◽

Brant Putnam ◽

Stanley R. Klein

Keyword(s):

Risk Factor ◽

Length Of Stay ◽

Hospital Mortality ◽

Independent Risk Factor ◽

Injury Severity ◽

Multiple Organ ◽

Independent Effect ◽

Trauma Patients ◽

Packed Red Blood Cells ◽

Icu Stay

The purpose of this study was to determine if the quantity and age of blood is an independent risk factor for in-hospital mortality, need for intensive care unit (ICU) care, and an increased length of stay in the ICU. This was a retrospective cohort study performed at a level I trauma center between 2001 and 2003. Consecutive trauma patients who received at least 1 unit of packed red blood cells (PRBCs) were included. The number of units of PRBCs transfused and the ages of each unit of PRBCs were recorded. Other variables including the patient's age, sex, Trauma-Related Injury Severity Score (TRISS), and whether the blood was leukopoor were collected. End points included in-hospital mortality, need for ICU care, and the length of stay in the ICU (in days). Multivariable logistic and Poisson regression analyses were performed to model the independent effect of the dose of aged blood (defined as the product of the average age of all units received and the total number of units received) with respect to each end point while controlling for age, TRISS, the total number of units administered, and the proportion of blood that was leukopoor. During the study period, 275 patients were studied. Patients who received older blood had a significantly longer ICU stay (RR 1.15, 95% CI: 1.11–1.20), possibly reflecting a higher level of organ dysfunction. Patients who received older blood, however, did not have a significantly higher in-hospital mortality rate (OR 1.21, 95% CI: 0.87–1.69) or a significantly higher need for ICU care (OR 1.20, 95% CI: 0.87–1.64). The quantity of aged blood is an independent risk factor for length of ICU care. This may be a proxy indicator for multiple organ failure. Further research is required to define which patients may benefit from newer blood.

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

10.21203/rs.3.rs-52207/v2 ◽

2020 ◽

Author(s):

Libing Jiang ◽

Zhongjun Zheng ◽

Mao Zhang

Keyword(s):

Hospital Mortality ◽

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Secondary Analysis ◽

Geriatric Trauma ◽

Trauma Patients ◽

Survival Group ◽

Change Tendency ◽

Death Group

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.

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Registry-Based Mortality Analysis Reveals a High Proportion of Patient Decrees and Presumed Limitation of Therapy in Severe Geriatric Trauma

Journal of Clinical Medicine ◽

10.3390/jcm9092686 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2686 ◽

Cited By ~ 1

Author(s):

Cora Rebecca Schindler ◽

Mathias Woschek ◽

René Danilo Verboket ◽

Ramona Sturm ◽

Nicolas Söhling ◽

...

Keyword(s):

Brain Injuries ◽

Injury Severity ◽

Geriatric Trauma ◽

Hospital Treatment ◽

Trauma Patients ◽

Severely Injured ◽

Severely Injured Patients ◽

Initial Care ◽

Limitation Of Therapy ◽

Injured Patients

Background: The treatment of severely injured patients, especially in older age, is complex, and based on strict guidelines. Methods: We conducted a retrospective study by analyzing our internal registry for mortality risk factors in deceased trauma patients. All patients that were admitted to the trauma bay of our level-1-trauma center from 2014 to 2018, and that died during the in-hospital treatment, were included. The aim of this study was to carry out a quality assurance concerning the initial care of severely injured patients. Results: In the 5-year period, 135 trauma patients died. The median (IQR) age was 69 (38–83) years, 71% were male, and the median (IQR) Injury Severity Score (ISS) was 25 (17–34) points. Overall, 41% of the patients suffered from severe traumatic brain injuries (TBI) (AIShead ≥ 4 points). For 12.7%, therapy was finally limited owing to an existing patient’s decree; in 64.9% with an uncertain prognosis, a ‘therapia minima’ was established in consensus with the relatives. Conclusion: Although the mortality rate was primarily related to the severity of the injury, a significant number of deaths were not exclusively due to medical reasons, but also to a self-determined limitation of therapy for severely injured geriatric patients. The conscientious documentation concerning the will of the patient is increasingly important in supporting medical decisions.

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