老年创伤患者的 1 年死亡率：利用社会保障死亡索引改进老年创伤结局评分。

One-year mortality in geriatric trauma patients: Improving upon the geriatric trauma outcomes score utilizing the social security death index.

机构信息

From the Division of Acute Care Surgery, Department of Surgery (S.W.R.), Carolinas Medical Center, Charlotte, North Carolina; Division of General and Acute Care Surgery, Department of Surgery (F.M.A., M.Z., A.T.M., M.W.C., H.A.P.), and Division of Surgical Oncology, Department of Surgery (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Texas.

出版信息

J Trauma Acute Care Surg. 2019 Nov;87(5):1148-1155. doi: 10.1097/TA.0000000000002441.

DOI:10.1097/TA.0000000000002441

PMID:31318764

Abstract

BACKGROUND

Geriatric Trauma Outcomes Score (GTOS) predicts in-patient mortality in geriatric trauma patients and has been validated in a prospective multicenter trial and expanded to predict adverse discharge (GTOS II). We hypothesized that these formulations actually underestimate the downstream sequelae of injury and sought to predict longer-term mortality in geriatric trauma patients.

METHODS

The Parkland Memorial Hospital Trauma registry was queried for patients 65 years or older from 2001 to 2013. Patients were then matched to the Social Security Death Index. The primary outcome was 1-year mortality. The original GTOS formula (variables of age, Injury Severity Score [ISS], 24-hour transfusion) was tested to predict 1-year mortality using receiver operator curves. Significant variables on univariate analysis were used to build an optimal multivariate model to predict 1-year mortality (GTOS III).

RESULTS

There were 3,262 patients who met inclusion. Inpatient mortality was 10.0% (324) and increased each year: 15.8%, 1 year; 17.8%, 2 years; and 22.6%, 5 years. The original GTOS equation had an area under the curve of 0.742 for 1-year mortality. Univariate analysis showed that patients with 1-year mortality had on average increased age (75.7 years vs. 79.5 years), ISS (11.1 vs. 19.1), lower GCS score (14.3 vs. 10.5), more likely to require transfusion within 24 hours (11.5% vs. 31.3%), and adverse discharge (19.5% vs. 78.2%; p < 0.0001 for all). Multivariate logistic regression was used to create the optimal equation to predict 1-year mortality: (GTOSIII = age + [0.806 × ISS] + 5.55 [if transfusion in first 24 hours] + 21.69 [if low GCS] + 34.36 [if adverse discharge]); area under the curve of 0.878.

CONCLUSION

Traumatic injury in geriatric patients is associated with high mortality rates at 1 year to 5 years. GTOS III has robust test characteristics to predict death at 1 year and can be used to guide patient centered goals discussions with objective data.

LEVEL OF EVIDENCE

Prognostic, level III.

摘要

背景

老年创伤结局评分（GTOS）可预测老年创伤患者的住院死亡率，并已在一项前瞻性多中心试验中得到验证，并扩展用于预测不良出院（GTOS II）。我们假设这些公式实际上低估了损伤的后续后果，并试图预测老年创伤患者的长期死亡率。

方法

从 2001 年至 2013 年，在 Parkland Memorial Hospital 创伤登记处查询 65 岁或以上的患者。然后，患者与社会保障死亡指数相匹配。主要结局是 1 年死亡率。使用接收者操作曲线测试原始 GTOS 公式（年龄、损伤严重程度评分 [ISS]、24 小时输血变量）来预测 1 年死亡率。单因素分析中的显著变量用于构建预测 1 年死亡率的最佳多变量模型（GTOS III）。

结果

共有 3262 名患者符合纳入标准。住院死亡率为 10.0%（324 人），且每年递增：1 年为 15.8%；2 年为 17.8%；5 年为 22.6%。原始 GTOS 方程对 1 年死亡率的曲线下面积为 0.742。单因素分析显示，1 年死亡率患者的平均年龄较高（75.7 岁比 79.5 岁）、ISS（11.1 比 19.1）、较低的 GCS 评分（14.3 比 10.5）、24 小时内更有可能需要输血（11.5%比 31.3%）以及不良出院（19.5%比 78.2%；所有比较均 p <0.0001）。多变量逻辑回归用于创建预测 1 年死亡率的最佳方程：（GTOSIII=年龄+[0.806×ISS]+5.55[如果在头 24 小时内输血]+21.69[如果 GCS 较低]+34.36[如果不良出院]）；曲线下面积为 0.878。