Han Jonghee, Yoon Su Young, Seok Junepill, Lee Jin Young, Lee Jin Suk, Ye Jin Bong, Sul Younghoon, Kim Se Heon, Kim Hong Rye
Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Korea.
Department of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Korea.
Ann Geriatr Med Res. 2024 Dec;28(4):484-490. doi: 10.4235/agmr.24.0095. Epub 2024 Aug 28.
This study aimed to validate the Geriatric Trauma Outcome Score (GTOS) for predicting mortality associated with trauma in older Korean adults and compare the GTOS with the Trauma and Injury Severity Score (TRISS).
This study included patients aged ≥65 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022. We used receiver operating characteristic curves and calibration plots to assess the discrimination and calibration of the scoring systems.
Among 3,053 patients, the median age was 77 years, and the mortality rate was 5.2%. The overall GTOS-predicted mortality and 1-TRISS were 5.4% (interquartile range [IQR], 3.7-9.5) and 4.7% (IQR, 4.7-4.7), respectively. The areas under the curves (AUCs) of 1-TRISS and GTOS for the total population were 0.763 (95% confidence interval [CI], 0.719-0.806) and 0.794 (95% CI, 0.755-0.833), respectively. In the Glasgow Coma Scale (GCS) ≤12 group, the in-hospital mortality rate was 27.5% (79 deaths). The GTOS-predicted mortality and 1-TRISS in this group were 18.6% (IQR, 7.5-34.7) and 26.9% (IQR, 11.9-73.1), respectively. The AUCs of 1-TRISS and GTOS for the total population were 0.800 (95% CI, 0.776-0.854) and 0.744 (95% CI, 0.685-0.804), respectively.
The GTOS and TRISS demonstrated comparable accuracy in predicting mortality, while the GTOS offered the advantage of simpler calculations. However, the GTOS tended to underestimate mortality in patients with GCS ≤12; thus, its application requires care in such cases.
本研究旨在验证老年创伤结局评分（GTOS）对预测韩国老年成人创伤相关死亡率的有效性，并将GTOS与创伤和损伤严重程度评分（TRISS）进行比较。
本研究纳入了2016年1月至2022年12月期间前往忠北国立大学医院地区创伤中心就诊的年龄≥65岁的患者。我们使用受试者工作特征曲线和校准图来评估评分系统的辨别力和校准情况。
在3053例患者中，中位年龄为77岁，死亡率为5.2%。GTOS预测的总体死亡率和1-TRISS分别为5.4%（四分位间距[IQR]，3.7-9.5）和4.7%（IQR，4.7-4.7）。1-TRISS和GTOS在总人群中的曲线下面积（AUC）分别为0.763（95%置信区间[CI]，0.719-0.806）和0.794（95%CI，0.755-0.833）。在格拉斯哥昏迷量表（GCS）≤12分的组中，住院死亡率为27.5%（79例死亡）。该组中GTOS预测的死亡率和1-TRISS分别为18.6%（IQR，7.5-34.7）和26.9%（IQR，11.9-73.1）。1-TRISS和GTOS在总人群中的AUC分别为0.800（95%CI，0.776-0.854）和0.744（95%CI，0.685-0.804）。
GTOS和TRISS在预测死亡率方面表现出相当的准确性，而GTOS具有计算更简单的优势。然而，GTOS往往会低估GCS≤12分患者的死亡率；因此，在这种情况下应用时需要谨慎。
