Efficacy of the Geriatric Trauma Outcome Score (GTOS) in Predicting Mortality in Trauma Patients: A Retrospective Cross-Sectional Study.

BACKGROUND

Trauma has a profound impact on mortality as well as short- and long-term health outcomes. For trauma patients to receive medical care in a timely manner, early identification and risk assessment are essential. The Geriatric Trauma Outcome Score (GTOS), which was created by combining age, the Injury Severity Score (ISS), and the requirement for packed red blood cell transfusion, has proven to be a valuable prognostic tool for elderly trauma patients, though its applicability to general trauma patients is still understudied.

METHODS

This retrospective study analyzed data from the Trauma Registry System at a Level I trauma center in southern Taiwan, covering the period from 1 January 2009 to 31 December 2021. This study included 40,068 trauma patients aged 20 years and older. Statistical analyses included chi-square tests, ANOVA, Mann-Whitney U tests, and multivariate analyses to identify independent risk factors for mortality. The predictive performance of the GTOS was assessed using the area under the curve (AUC) of the receiver operating characteristic curve.

RESULTS

The final study population included 40,068 patients, with 818 deaths and 39,250 survivors. Deceased patients had higher GTOS scores (mean 132.8 vs. 76.1, < 0.001) and required more blood transfusions (mean 4.0 vs. 0.3 units, < 0.001) compared to survivors. The optimal GTOS cut-off value for predicting mortality was 104.5, with a sensitivity of 82.6% and a specificity of 84.3% (AUC = 0.917). A high GTOS score was associated with increased mortality (9.6 vs. 0.4%, < 0.001) compared with a low GTOS score, even after adjusting for confounding factors (adjusted mortality rate of 2.86, < 0.001), and a longer hospital stay (14.0 vs. 7.7 days, < 0.001).

CONCLUSIONS

The GTOS is a valuable prognostic tool for predicting mortality in trauma patients, providing a simple and rapid assessment method. Its high predictive accuracy supports its use in broader trauma patient populations beyond the elderly. Further studies are recommended to refine and validate the GTOS in diverse trauma settings to enhance its clinical utility.