Cook Allyson C, Joseph Bellal, Mohler M Jane, Inaba Kenji, Bruns Brandon R, Nakonezny Paul A, Kerby Jeff D, Brasel Karen J, Wolf Steven E, Cuschieri Joseph, Paulk M Elizabeth, Rhodes Ramona L, Brakenridge Scott C, Ekeh A Peter, Phelan Herb A
UT Southwestern Department of Surgery, Division of Burns/Trauma/Critical Care, Parkland Memorial Hospital, Dallas, Texas.
Critical Care, Burn, and Emergency Surgery, University of Arizona Division of Trauma, Tucson, Arizona.
J Am Geriatr Soc. 2017 Oct;65(10):2302-2307. doi: 10.1111/jgs.15009. Epub 2017 Aug 14.
BACKGROUND/OBJECTIVES: The P.A.L.Li.A.T.E. (prognostic assessment of life and limitations after trauma in the elderly) consortium has previously created a prognosis calculator for mortality after geriatric injury based on age, injury severity, and transfusion requirement called the geriatric trauma outcome score (GTOS). Here, we sought to create and validate a prognosis calculator called the geriatric trauma outcome score ii (GTOS II) estimating probability of unfavorable discharge.
Retrospective cohort.
Four geographically diverse Level 1 trauma centers.
Trauma admissions aged 65 to 102 years surviving to discharge from 2000 to 2013.
None.
Age, injury severity score (ISS), transfusion at 24 hours post-admission, discharge dichotomized as favorable (home/rehabilitation) or unfavorable (skilled nursing/long term acute care/hospice). Training and testing samples were created using the holdout method. A multiple logistic mixed model (GTOS II) was created to estimate the odds of unfavorable disposition then re-specified using the GTOS II as the sole predictor in a logistic mixed model using the testing sample.
The final dataset was 16,114 subjects (unfavorable discharge status = 15.4%). Training (n = 8,057) and testing (n = 8,057) samples had similar demographics. The formula based on the training sample was (GTOS II = Age + [0.71 × ISS] + 8.79 [if transfused by 24 hours]). Misclassification rate and AUC were 15.63% and 0.67 for the training sample, respectively, and 15.85% and 0.67 for the testing sample.
GTOS II estimates the probability of unfavorable discharge in injured elders with moderate accuracy. With the GTOS mortality calculator, it can help in goal setting conversations after geriatric injury.
背景/目的：P.A.L.Li.A.T.E.（老年创伤后生活与限制的预后评估）联盟此前基于年龄、损伤严重程度和输血需求创建了一个老年创伤后死亡率预后计算器，称为老年创伤结局评分（GTOS）。在此，我们试图创建并验证一个名为老年创伤结局评分ii（GTOS II）的预后计算器，以估计不良出院的概率。
回顾性队列研究。
四个地理位置不同的一级创伤中心。
2000年至2013年存活至出院的65至102岁创伤入院患者。
无。
年龄、损伤严重程度评分（ISS）、入院后24小时输血情况、出院情况分为良好（回家/康复）或不良（专业护理/长期急性护理/临终关怀）。使用留出法创建训练和测试样本。创建一个多重逻辑混合模型（GTOS II）来估计不良处置的几率，然后在使用测试样本的逻辑混合模型中以GTOS II作为唯一预测因子重新指定。
最终数据集为16114名受试者（不良出院状态 = 15.4%）。训练样本（n = 8057）和测试样本（n = 8057）的人口统计学特征相似。基于训练样本的公式为（GTOS II = 年龄 + [0.71×ISS] + 8.79 [如果在24小时内输血]）。训练样本的误分类率和AUC分别为15.63%和0.67，测试样本为15.85%和0.67。
GTOS II对受伤老年人不良出院概率的估计具有中等准确性。与GTOS死亡率计算器一起，它有助于老年创伤后的目标设定讨论。
