A comparison of prognosis calculators for geriatric trauma

A Prognostic Assessment of Life and Limitations after Trauma in the Elderly consortium study

Tarik David Madni, Akpofure Peter Ekeh, Scott C. Brakenridge, Karen J. Brasel, Bellal Joseph, Kenji Inaba, Brandon R. Bruns, Jeffrey D. Kerby, Joseph Cuschieri, M. Jane Mohler, Paul A. Nakonezny, Audra Clark, Jonathan Imran, Steven Wolf, M. Elizabeth Paulk, Ramona L. Rhodes, Herb A. Phelan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND The nine-center Prognostic Assessment of Life and Limitations After Trauma in the Elderly consortium has validated the Geriatric Trauma Outcome Score (GTOS) as a prognosis calculator for injured elders. We compared GTOS' performance to that of the Trauma Injury Severity Score (TRISS) in a multicenter sample. METHODS Three Prognostic Assessment of Life and Limitations After Trauma in the Elderly centers not submitting subjects to the GTOS validation study identified subjects aged 65 years to 102 years admitted from 2000 to 2013. GTOS was specified using the formula [GTOS = age + (Injury Severity Score [ISS] × 2.5) + 22 (if transfused packed red cells (PRC) at 24 hours)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 years = 0 and ≥55 years = 1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISS P = -2.5355 + (0.9934 × RTS) + (-0.0651 × ISS) + (-1.1360 × Age)]. TRISS Blunt was specified as [TRISS B = -0.4499 + (0.8085 × RTS Total) + (-0.0835 × ISS) + (-1.7430 × Age)]. Each then became the sole predictor in a separate logistic regression model to estimate probability of mortality. Model performances were evaluated using misclassification rate, Brier score, and area under the curve. RESULTS Demographics (mean + SD) of subjects with complete data (N = 10,894) were age, 78.3 years ± 8.1 years; ISS, 10.9 ± 8.4; RTS = 7.5 ± 1.1; mortality = 6.9%; blunt mechanism = 98.6%; 3.1 % of subjects received PRCs. The penetrating trauma subsample (n = 150) had a higher mortality rate of 20.0%. The misclassification rates for the models were GTOS, 0.065; TRISS B, 0.051; and TRISS P, 0.120. Brier scores were GTOS, 0.052; TRISS B, 0.041; and TRISS P, 0.084. The area under the curves were GTOS, 0.844; TRISS B, 0.889; and TRISS P, 0.897. CONCLUSION GTOS and TRISS function similarly and accurately in predicting probability of death for injured elders. GTOS has the advantages of a single formula, fewer variables, and no reliance on data collected in the emergency room or by other observers. LEVEL OF EVIDENCE Prognostic, level II.

Original languageEnglish (US)
Pages (from-to)90-96
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume83
Issue number1
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

Fingerprint

Geriatrics
Injury Severity Score
Wounds and Injuries
Area Under Curve
Mortality
Logistic Models

Keywords

  • elderly
  • Geriatric
  • prognosis
  • score
  • trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

A comparison of prognosis calculators for geriatric trauma : A Prognostic Assessment of Life and Limitations after Trauma in the Elderly consortium study. / Madni, Tarik David; Ekeh, Akpofure Peter; Brakenridge, Scott C.; Brasel, Karen J.; Joseph, Bellal; Inaba, Kenji; Bruns, Brandon R.; Kerby, Jeffrey D.; Cuschieri, Joseph; Mohler, M. Jane; Nakonezny, Paul A.; Clark, Audra; Imran, Jonathan; Wolf, Steven; Paulk, M. Elizabeth; Rhodes, Ramona L.; Phelan, Herb A.

In: Journal of Trauma and Acute Care Surgery, Vol. 83, No. 1, 01.07.2017, p. 90-96.

Research output: Contribution to journalArticle

Madni, TD, Ekeh, AP, Brakenridge, SC, Brasel, KJ, Joseph, B, Inaba, K, Bruns, BR, Kerby, JD, Cuschieri, J, Mohler, MJ, Nakonezny, PA, Clark, A, Imran, J, Wolf, S, Paulk, ME, Rhodes, RL & Phelan, HA 2017, 'A comparison of prognosis calculators for geriatric trauma: A Prognostic Assessment of Life and Limitations after Trauma in the Elderly consortium study', Journal of Trauma and Acute Care Surgery, vol. 83, no. 1, pp. 90-96. https://doi.org/10.1097/TA.0000000000001506
Madni, Tarik David ; Ekeh, Akpofure Peter ; Brakenridge, Scott C. ; Brasel, Karen J. ; Joseph, Bellal ; Inaba, Kenji ; Bruns, Brandon R. ; Kerby, Jeffrey D. ; Cuschieri, Joseph ; Mohler, M. Jane ; Nakonezny, Paul A. ; Clark, Audra ; Imran, Jonathan ; Wolf, Steven ; Paulk, M. Elizabeth ; Rhodes, Ramona L. ; Phelan, Herb A. / A comparison of prognosis calculators for geriatric trauma : A Prognostic Assessment of Life and Limitations after Trauma in the Elderly consortium study. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 83, No. 1. pp. 90-96.
@article{81fed99f79ad49a2baae1fd5a1cfa245,
title = "A comparison of prognosis calculators for geriatric trauma: A Prognostic Assessment of Life and Limitations after Trauma in the Elderly consortium study",
abstract = "BACKGROUND The nine-center Prognostic Assessment of Life and Limitations After Trauma in the Elderly consortium has validated the Geriatric Trauma Outcome Score (GTOS) as a prognosis calculator for injured elders. We compared GTOS' performance to that of the Trauma Injury Severity Score (TRISS) in a multicenter sample. METHODS Three Prognostic Assessment of Life and Limitations After Trauma in the Elderly centers not submitting subjects to the GTOS validation study identified subjects aged 65 years to 102 years admitted from 2000 to 2013. GTOS was specified using the formula [GTOS = age + (Injury Severity Score [ISS] × 2.5) + 22 (if transfused packed red cells (PRC) at 24 hours)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 years = 0 and ≥55 years = 1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISS P = -2.5355 + (0.9934 × RTS) + (-0.0651 × ISS) + (-1.1360 × Age)]. TRISS Blunt was specified as [TRISS B = -0.4499 + (0.8085 × RTS Total) + (-0.0835 × ISS) + (-1.7430 × Age)]. Each then became the sole predictor in a separate logistic regression model to estimate probability of mortality. Model performances were evaluated using misclassification rate, Brier score, and area under the curve. RESULTS Demographics (mean + SD) of subjects with complete data (N = 10,894) were age, 78.3 years ± 8.1 years; ISS, 10.9 ± 8.4; RTS = 7.5 ± 1.1; mortality = 6.9{\%}; blunt mechanism = 98.6{\%}; 3.1 {\%} of subjects received PRCs. The penetrating trauma subsample (n = 150) had a higher mortality rate of 20.0{\%}. The misclassification rates for the models were GTOS, 0.065; TRISS B, 0.051; and TRISS P, 0.120. Brier scores were GTOS, 0.052; TRISS B, 0.041; and TRISS P, 0.084. The area under the curves were GTOS, 0.844; TRISS B, 0.889; and TRISS P, 0.897. CONCLUSION GTOS and TRISS function similarly and accurately in predicting probability of death for injured elders. GTOS has the advantages of a single formula, fewer variables, and no reliance on data collected in the emergency room or by other observers. LEVEL OF EVIDENCE Prognostic, level II.",
keywords = "elderly, Geriatric, prognosis, score, trauma",
author = "Madni, {Tarik David} and Ekeh, {Akpofure Peter} and Brakenridge, {Scott C.} and Brasel, {Karen J.} and Bellal Joseph and Kenji Inaba and Bruns, {Brandon R.} and Kerby, {Jeffrey D.} and Joseph Cuschieri and Mohler, {M. Jane} and Nakonezny, {Paul A.} and Audra Clark and Jonathan Imran and Steven Wolf and Paulk, {M. Elizabeth} and Rhodes, {Ramona L.} and Phelan, {Herb A.}",
year = "2017",
month = "7",
day = "1",
doi = "10.1097/TA.0000000000001506",
language = "English (US)",
volume = "83",
pages = "90--96",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - A comparison of prognosis calculators for geriatric trauma

T2 - A Prognostic Assessment of Life and Limitations after Trauma in the Elderly consortium study

AU - Madni, Tarik David

AU - Ekeh, Akpofure Peter

AU - Brakenridge, Scott C.

AU - Brasel, Karen J.

AU - Joseph, Bellal

AU - Inaba, Kenji

AU - Bruns, Brandon R.

AU - Kerby, Jeffrey D.

AU - Cuschieri, Joseph

AU - Mohler, M. Jane

AU - Nakonezny, Paul A.

AU - Clark, Audra

AU - Imran, Jonathan

AU - Wolf, Steven

AU - Paulk, M. Elizabeth

AU - Rhodes, Ramona L.

AU - Phelan, Herb A.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - BACKGROUND The nine-center Prognostic Assessment of Life and Limitations After Trauma in the Elderly consortium has validated the Geriatric Trauma Outcome Score (GTOS) as a prognosis calculator for injured elders. We compared GTOS' performance to that of the Trauma Injury Severity Score (TRISS) in a multicenter sample. METHODS Three Prognostic Assessment of Life and Limitations After Trauma in the Elderly centers not submitting subjects to the GTOS validation study identified subjects aged 65 years to 102 years admitted from 2000 to 2013. GTOS was specified using the formula [GTOS = age + (Injury Severity Score [ISS] × 2.5) + 22 (if transfused packed red cells (PRC) at 24 hours)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 years = 0 and ≥55 years = 1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISS P = -2.5355 + (0.9934 × RTS) + (-0.0651 × ISS) + (-1.1360 × Age)]. TRISS Blunt was specified as [TRISS B = -0.4499 + (0.8085 × RTS Total) + (-0.0835 × ISS) + (-1.7430 × Age)]. Each then became the sole predictor in a separate logistic regression model to estimate probability of mortality. Model performances were evaluated using misclassification rate, Brier score, and area under the curve. RESULTS Demographics (mean + SD) of subjects with complete data (N = 10,894) were age, 78.3 years ± 8.1 years; ISS, 10.9 ± 8.4; RTS = 7.5 ± 1.1; mortality = 6.9%; blunt mechanism = 98.6%; 3.1 % of subjects received PRCs. The penetrating trauma subsample (n = 150) had a higher mortality rate of 20.0%. The misclassification rates for the models were GTOS, 0.065; TRISS B, 0.051; and TRISS P, 0.120. Brier scores were GTOS, 0.052; TRISS B, 0.041; and TRISS P, 0.084. The area under the curves were GTOS, 0.844; TRISS B, 0.889; and TRISS P, 0.897. CONCLUSION GTOS and TRISS function similarly and accurately in predicting probability of death for injured elders. GTOS has the advantages of a single formula, fewer variables, and no reliance on data collected in the emergency room or by other observers. LEVEL OF EVIDENCE Prognostic, level II.

AB - BACKGROUND The nine-center Prognostic Assessment of Life and Limitations After Trauma in the Elderly consortium has validated the Geriatric Trauma Outcome Score (GTOS) as a prognosis calculator for injured elders. We compared GTOS' performance to that of the Trauma Injury Severity Score (TRISS) in a multicenter sample. METHODS Three Prognostic Assessment of Life and Limitations After Trauma in the Elderly centers not submitting subjects to the GTOS validation study identified subjects aged 65 years to 102 years admitted from 2000 to 2013. GTOS was specified using the formula [GTOS = age + (Injury Severity Score [ISS] × 2.5) + 22 (if transfused packed red cells (PRC) at 24 hours)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 years = 0 and ≥55 years = 1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISS P = -2.5355 + (0.9934 × RTS) + (-0.0651 × ISS) + (-1.1360 × Age)]. TRISS Blunt was specified as [TRISS B = -0.4499 + (0.8085 × RTS Total) + (-0.0835 × ISS) + (-1.7430 × Age)]. Each then became the sole predictor in a separate logistic regression model to estimate probability of mortality. Model performances were evaluated using misclassification rate, Brier score, and area under the curve. RESULTS Demographics (mean + SD) of subjects with complete data (N = 10,894) were age, 78.3 years ± 8.1 years; ISS, 10.9 ± 8.4; RTS = 7.5 ± 1.1; mortality = 6.9%; blunt mechanism = 98.6%; 3.1 % of subjects received PRCs. The penetrating trauma subsample (n = 150) had a higher mortality rate of 20.0%. The misclassification rates for the models were GTOS, 0.065; TRISS B, 0.051; and TRISS P, 0.120. Brier scores were GTOS, 0.052; TRISS B, 0.041; and TRISS P, 0.084. The area under the curves were GTOS, 0.844; TRISS B, 0.889; and TRISS P, 0.897. CONCLUSION GTOS and TRISS function similarly and accurately in predicting probability of death for injured elders. GTOS has the advantages of a single formula, fewer variables, and no reliance on data collected in the emergency room or by other observers. LEVEL OF EVIDENCE Prognostic, level II.

KW - elderly

KW - Geriatric

KW - prognosis

KW - score

KW - trauma

UR - http://www.scopus.com/inward/record.url?scp=85017619070&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017619070&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000001506

DO - 10.1097/TA.0000000000001506

M3 - Article

VL - 83

SP - 90

EP - 96

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -