ASA Physical Status Classification Improves Predictive Ability of a Validated Trauma Risk Score

Area of Science:

• Geriatric Trauma Care
• Trauma Triage Tools
• Risk Stratification Models

Background:

• The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated tool for assessing mortality risk in trauma patients.
• Key criteria include age, comorbidities, vital signs, and injuries.

Purpose of the Study:

• To evaluate if incorporating the ASA physical status classification system into the STTGMA improves risk stratification for middle-aged and elderly trauma patients.
• To enhance the predictive accuracy of the STTGMA for inpatient mortality.

Main Methods:

• 1332 patients aged 55+ with low-energy hip fractures were analyzed.
• STTGMA and STTGMA with ASA (STTGMAASA) scores were calculated.
• Model predictive performance for inpatient mortality was compared using AUROCs and DeLong's test.

Main Results:

• STTGMAASA demonstrated a significantly higher predictive capacity for inpatient mortality (AUROC 0.823) compared to STTGMA (AUROC 0.742, p=0.04).
• Risk stratification using STTGMAASA showed a significantly different distribution of mortality, complications, and length of stay across risk cohorts (p<0.01).
• Total hospital cost was correlated with both STTGMAASA and STTGMA scores.

Conclusions:

• The addition of ASA physical status classification enhances the STTGMA's ability to predict inpatient mortality in geriatric and middle-aged hip fracture patients.
• STTGMAASA provides improved risk stratification, aiding clinical decision-making and resource allocation for this demographic.