Predicting survival in geriatric trauma patients: A comparison between the TRISS methodology and the Geriatric Trauma Outcome Score.

INTRODUCTION

We compared the Geriatric Trauma Outcome Score (GTOS) with the probability of survival using the TRISS methodology (PS-TRISS) in geriatric severe trauma patients admitted to Intensive Care Units (ICU) participating in the Spanish trauma ICU registry (RETRAUCI).

METHODS

Retrospective analysis from the RETRAUCI. Quantitative data were reported as median (Interquartile Range (IQR)), and categorical data as number (percentage). We analyzed the validity of the GTOS and PS-TRISS to predict survival. Discrimination was analyzed using receiver operating characteristics curves. Calibration was analyzed using the Hosmer-Lemeshow goodness-of-fit test. A P value <.05 was considered statistically significant.

RESULTS

The cohort included 1417 patients aged ≥ 65 years. Median age was 75.5 (70.5-80.5), 1003 patients were male (68.2%) and median Injury Severity Score was 18 (13-25). Mechanical ventilation was required in 61%. Falls were the mechanism of injury in 659 patients (44.8%). In-hospital mortality rate was 18.2%. The areas under the curve were: PS-TRISS 0.69 (95%CI 0.66-0.73), and GTOS 0.66 (95%CI 0.62-0.70); P<.05. Both scores overestimated mortality in the upper range of predicted mortality.

CONCLUSIONS

In our sample of geriatric severe trauma patients, the accuracy of GTOS was lower than the accuracy of the PS-TRISS to predict in-hospital survival. The calibration of both scores for the geriatric population was deficient.