Validation of a Geriatric Trauma Prognosis Calculator: A P.A.L.Li.A.T.E. Consortium Study

Area of Science:

• Geriatric Trauma Research
• Prognostic Modeling
• Healthcare Outcomes

Background:

• The P.A.L.Li.A.T.E. consortium previously developed the Geriatric Trauma Outcome Score (GTOS) for mortality prediction.
• Existing tools focus on mortality, necessitating a new calculator for discharge disposition.

Purpose of the Study:

• To develop and validate the Geriatric Trauma Outcome Score II (GTOS II) calculator.
• GTOS II aims to estimate the probability of unfavorable discharge in elderly trauma patients.

Main Methods:

• Retrospective cohort study across four Level 1 trauma centers.
• Included trauma admissions aged 65-102 years surviving to discharge (2000-2013).
• Developed a logistic mixed-effects model using age, Injury Severity Score (ISS), and transfusion status.

Main Results:

• The study included 16,114 subjects; 15.4% had an unfavorable discharge.
• The GTOS II formula is: Age + (0.71 × ISS) + 8.79 (if transfused by 24 hours).
• The calculator demonstrated moderate accuracy with a misclassification rate of ~15.8% and AUC of 0.67 on the testing sample.

Conclusions:

• GTOS II provides a moderate estimation of unfavorable discharge probability in elderly trauma patients.
• This calculator, alongside GTOS for mortality, can facilitate goal-setting conversations post-injury.