老年创伤结局评分的多中心外部验证：老年创伤后生活与局限性预后评估（PALLIATE）联盟的一项研究。
Multicenter external validation of the Geriatric Trauma Outcome Score: A study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly (PALLIATE) consortium.
作者信息
Cook Allyson C, Joseph Bellal, Inaba Kenji, Nakonezny Paul A, Bruns Brandon R, Kerby Jeff D, Brasel Karen J, Wolf Steve E, Cuschieri Joe, Paulk M Elizabeth, Rhodes Ramona L, Brakenridge Scott C, Phelan Herb A
机构信息
From the Department of Surgery (A.C.C.), Division of Biostatistics (P.A.N.), Department of Clinical Sciences, Division of Burns/Trauma/Critical Care (S.E.W., H.A.P.), Palliative Medicine (M.E.P.), Department of Internal Medicine, and Palliative Medicine (R.L.R.), Division of Geriatrics, UT Southwestern, Dallas, Texas; Division of Trauma, Critical Care, Burn, and Emergency Surgery (B.J.), University of Arizona, Tucson, Arizona; Division of Acute Care Surgery and Surgical Critical Care (K.I.), USC, Los Angeles, California; R Adams Cowley Shock Trauma Center (B.R.B.), University of Maryland; Baltimore, Maryland; Division of Trauma, Burns, and Surgical Critical Care (J.D.K.), UAB Medical Center, Birmingham, Alabama; Division of Trauma, Critical Care, and Acute Care Surgery (K.J.B.), Oregon Health Sciences University, Portland, Oregon; Division of Trauma, Burn, and Critical Care Surgery (J.C.), University of Washington, Seattle, Washington; and Division of Acute Care Surgery (S.C.B.), University of Florida, Gainesville, Florida.
出版信息
J Trauma Acute Care Surg. 2016 Feb;80(2):204-9. doi: 10.1097/TA.0000000000000926.
BACKGROUND
A prognostic tool for geriatric mortality after injury called the Geriatric Trauma Outcome Score (GTOS), where GTOS = [age] + [ISS × 2.5] + [22 if transfused any PRBCs by 24 hours after admission], was previously developed based on 13 years of data from geriatric trauma patients admitted to Parkland Hospital. We sought to validate this model.
METHODS
Four Level I centers identified subjects who are 65 years or older for the period of the original study. The GTOS model was first specified using the formula [GTOS = age + (ISS × 2.5) + 22 (if given PRBC by 24 hours)] developed from the Parkland sample and then used as the sole predictor in a logistic mixed model estimating probability of mortality in the validation sample, accounting for site as a random effect. We estimated the misclassification (error) rate, Brier score, Tjur R, and the area under the curve in evaluating the predictive performance of the GTOS model.
RESULTS
The original Parkland sample (n = 3,841) had a mean (SD) age of 76.6 (8.1) years, mean (SD) ISS of 12.4 (9.9), mortality of 10.8%, and 11.9% receiving PRBCs at 24 hours. The validation sample (n = 18,282) had a mean (SD) age of 77.0 (8.1) years, mean (SD) ISS of 12.3 (10.6), mortality of 11.0%, and 14.1% receiving PRBCs at 24 hours. Fitting the GTOS model to the validation sample revealed that the parameter estimates from the validation sample were similar to those of fitting it to the Parkland sample with highly overlapping 95% confidence limits. The misclassification (error) rate for the GTOS logistic model applied to the validation sample was 9.97%, similar to that of the Parkland sample (9.79%). Brier score, Tjur R, and the area under the curve for the GTOS logistic model when applied to the validation sample were 0.07, 0.25, and 0.86, respectively, compared with 0.08, 0.20, and 0.82, respectively, for the Parkland sample.
CONCLUSION
With the use of the data available at 24 hours after injury, the GTOS accurately predicts in-hospital mortality for the injured elderly.
LEVEL OF EVIDENCE
Prognostic study, level III.
背景
一种用于评估老年创伤患者死亡率的预后工具——老年创伤预后评分（GTOS），其计算公式为GTOS = [年龄] + [损伤严重度评分（ISS）×2.5] + [入院后24小时内输注任何浓缩红细胞则加22]，该公式基于帕克兰医院13年的老年创伤患者数据制定。我们旨在验证该模型。
方法
四个一级中心确定了原始研究期间65岁及以上的受试者。GTOS模型首先使用从帕克兰样本得出的公式[GTOS = 年龄 + （ISS×2.5） + 22（24小时内输注浓缩红细胞则加）]进行设定，然后在逻辑混合模型中用作唯一预测因子，估计验证样本中的死亡概率，将研究地点作为随机效应纳入考量。我们在评估GTOS模型的预测性能时，估计了误分类（误差）率、Brier评分、Tjur R以及曲线下面积。
结果
原始的帕克兰样本（n = 3841）的平均（标准差）年龄为76.6（8.1）岁，平均（标准差）ISS为12.4（9.9），死亡率为10.8%，24小时内接受浓缩红细胞输注的比例为11.9%。验证样本（n = 18282）的平均（标准差）年龄为77.0（8.1）岁，平均（标准差）ISS为12.3（10.6），死亡率为11.0%，24小时内接受浓缩红细胞输注的比例为14.1%。将GTOS模型应用于验证样本显示，验证样本的参数估计值与应用于帕克兰样本时相似，95%置信区间高度重叠。应用于验证样本的GTOS逻辑模型的误分类（误差）率为9.97%，与帕克兰样本的9.79%相似。应用于验证样本时，GTOS逻辑模型的Brier评分、Tjur R和曲线下面积分别为0.07、0.25和0.86，而帕克兰样本的相应值分别为0.08、0.20和0.82。
结论
利用受伤后24小时内可得的数据，GTOS能准确预测老年创伤患者的院内死亡率。
证据级别
预后研究，三级。
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