A comparison of prognosis calculators for geriatric trauma: A P.A.L.LI.A.T.E. consortium study

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

Research output: Research - peer-reviewArticle

Abstract

BACKGROUND: The nine-center PALLIATE 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 PALLIATE centers not submitting subjects to the GTOS validation study identified subjects aged 65 to 102 yrs admitted from 2000-2013. GTOS was specified using the formula [GTOS = age + (ISS x 2.5) + 22 (if transfused packed red cells (PRC) at 24 hrs)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 yrs=0 and ≥55 yrs=1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISSP = -2.5355 + (0.9934 x RTS) + (-0.0651 x ISS) + (-1.1360 x Age)]. TRISS Blunt was specified as [TRISSB = -0.4499 + (0.8085 x RTS Total) + (-0.0835 x ISS) + (-1.7430 x 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 (AUC). RESULTS: Demographics (mean + SD) of subjects with complete data (N=10,894) were age=78.3 yrs±8.1; 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 sub-sample (n=150) had a higher mortality rate of 20.0%. The misclassification rates for the models were GTOS=0.065, TRISSB=0.051, and TRISSP=0.120. Brier scores were GTOS=0.052, TRISSB=0.041, and TRISSP=0.084. The AUCs were GTOS=0.844, TRISSB=0.889, and TRISSP=0.897. CONCLUSIONS: 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: Level II, prognostic

LanguageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - Apr 18 2017

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Geriatrics
Wounds and Injuries
Injury Severity Score
Mortality
Area Under Curve
Logistic Models
Validation Studies
Hospital Emergency Service
Demography

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

A comparison of prognosis calculators for geriatric trauma : A P.A.L.LI.A.T.E. consortium study. / Madni, Tarik D.D.; Ekeh, Akpofure Peter; Brakenridge, Scott C.C.; Brasel, Karen J.; Joseph, Bellal; Inaba, Kenji; Bruns, Brandon R.; Kerby, Jeffrey D.; Cuschieri, Joseph; Mohler, Jane J.; Nakonezny, Paul A.; Clark, Audra; Imran, Jonathan; Wolf, Steven E.; Paulk, Elizabeth E.; Rhodes, Ramona L.; Phelan, Herb A.

In: Journal of Trauma and Acute Care Surgery, 18.04.2017.

Research output: Research - peer-reviewArticle

Madni, TDD, Ekeh, AP, Brakenridge, SCC, Brasel, KJ, Joseph, B, Inaba, K, Bruns, BR, Kerby, JD, Cuschieri, J, Mohler, JJ, Nakonezny, PA, Clark, A, Imran, J, Wolf, SE, Paulk, EE, Rhodes, RL & Phelan, HA 2017, 'A comparison of prognosis calculators for geriatric trauma: A P.A.L.LI.A.T.E. consortium study' Journal of Trauma and Acute Care Surgery. DOI: 10.1097/TA.0000000000001506
Madni, Tarik D.D. ; Ekeh, Akpofure Peter ; Brakenridge, Scott C.C. ; Brasel, Karen J. ; Joseph, Bellal ; Inaba, Kenji ; Bruns, Brandon R. ; Kerby, Jeffrey D. ; Cuschieri, Joseph ; Mohler, Jane J. ; Nakonezny, Paul A. ; Clark, Audra ; Imran, Jonathan ; Wolf, Steven E. ; Paulk, Elizabeth E. ; Rhodes, Ramona L. ; Phelan, Herb A./ A comparison of prognosis calculators for geriatric trauma : A P.A.L.LI.A.T.E. consortium study. In: Journal of Trauma and Acute Care Surgery. 2017
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title = "A comparison of prognosis calculators for geriatric trauma: A P.A.L.LI.A.T.E. consortium study",
abstract = "BACKGROUND: The nine-center PALLIATE 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 PALLIATE centers not submitting subjects to the GTOS validation study identified subjects aged 65 to 102 yrs admitted from 2000-2013. GTOS was specified using the formula [GTOS = age + (ISS x 2.5) + 22 (if transfused packed red cells (PRC) at 24 hrs)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 yrs=0 and ≥55 yrs=1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISSP = -2.5355 + (0.9934 x RTS) + (-0.0651 x ISS) + (-1.1360 x Age)]. TRISS Blunt was specified as [TRISSB = -0.4499 + (0.8085 x RTS Total) + (-0.0835 x ISS) + (-1.7430 x 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 (AUC). RESULTS: Demographics (mean + SD) of subjects with complete data (N=10,894) were age=78.3 yrs±8.1; 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 sub-sample (n=150) had a higher mortality rate of 20.0%. The misclassification rates for the models were GTOS=0.065, TRISSB=0.051, and TRISSP=0.120. Brier scores were GTOS=0.052, TRISSB=0.041, and TRISSP=0.084. The AUCs were GTOS=0.844, TRISSB=0.889, and TRISSP=0.897. CONCLUSIONS: 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: Level II, prognostic",
author = "Madni, {Tarik D.D.} and Ekeh, {Akpofure Peter} and Brakenridge, {Scott C.C.} and Brasel, {Karen J.} and Bellal Joseph and Kenji Inaba and Bruns, {Brandon R.} and Kerby, {Jeffrey D.} and Joseph Cuschieri and Mohler, {Jane J.} and Nakonezny, {Paul A.} and Audra Clark and Jonathan Imran and Wolf, {Steven E.} and Paulk, {Elizabeth E.} and Rhodes, {Ramona L.} and Phelan, {Herb A.}",
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T1 - A comparison of prognosis calculators for geriatric trauma

T2 - Journal of Trauma and Acute Care Surgery

AU - Madni,Tarik D.D.

AU - Ekeh,Akpofure Peter

AU - Brakenridge,Scott C.C.

AU - Brasel,Karen J.

AU - Joseph,Bellal

AU - Inaba,Kenji

AU - Bruns,Brandon R.

AU - Kerby,Jeffrey D.

AU - Cuschieri,Joseph

AU - Mohler,Jane J.

AU - Nakonezny,Paul A.

AU - Clark,Audra

AU - Imran,Jonathan

AU - Wolf,Steven E.

AU - Paulk,Elizabeth E.

AU - Rhodes,Ramona L.

AU - Phelan,Herb A.

PY - 2017/4/18

Y1 - 2017/4/18

N2 - BACKGROUND: The nine-center PALLIATE 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 PALLIATE centers not submitting subjects to the GTOS validation study identified subjects aged 65 to 102 yrs admitted from 2000-2013. GTOS was specified using the formula [GTOS = age + (ISS x 2.5) + 22 (if transfused packed red cells (PRC) at 24 hrs)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 yrs=0 and ≥55 yrs=1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISSP = -2.5355 + (0.9934 x RTS) + (-0.0651 x ISS) + (-1.1360 x Age)]. TRISS Blunt was specified as [TRISSB = -0.4499 + (0.8085 x RTS Total) + (-0.0835 x ISS) + (-1.7430 x 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 (AUC). RESULTS: Demographics (mean + SD) of subjects with complete data (N=10,894) were age=78.3 yrs±8.1; 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 sub-sample (n=150) had a higher mortality rate of 20.0%. The misclassification rates for the models were GTOS=0.065, TRISSB=0.051, and TRISSP=0.120. Brier scores were GTOS=0.052, TRISSB=0.041, and TRISSP=0.084. The AUCs were GTOS=0.844, TRISSB=0.889, and TRISSP=0.897. CONCLUSIONS: 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: Level II, prognostic

AB - BACKGROUND: The nine-center PALLIATE 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 PALLIATE centers not submitting subjects to the GTOS validation study identified subjects aged 65 to 102 yrs admitted from 2000-2013. GTOS was specified using the formula [GTOS = age + (ISS x 2.5) + 22 (if transfused packed red cells (PRC) at 24 hrs)]. TRISS uses the Revised Trauma Score (RTS), dichotomizes age (<55 yrs=0 and ≥55 yrs=1), and was specified using the updated 1995 beta coefficients. TRISS Penetrating was specified as [TRISSP = -2.5355 + (0.9934 x RTS) + (-0.0651 x ISS) + (-1.1360 x Age)]. TRISS Blunt was specified as [TRISSB = -0.4499 + (0.8085 x RTS Total) + (-0.0835 x ISS) + (-1.7430 x 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 (AUC). RESULTS: Demographics (mean + SD) of subjects with complete data (N=10,894) were age=78.3 yrs±8.1; 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 sub-sample (n=150) had a higher mortality rate of 20.0%. The misclassification rates for the models were GTOS=0.065, TRISSB=0.051, and TRISSP=0.120. Brier scores were GTOS=0.052, TRISSB=0.041, and TRISSP=0.084. The AUCs were GTOS=0.844, TRISSB=0.889, and TRISSP=0.897. CONCLUSIONS: 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: Level II, prognostic

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