Geriatric Trauma Outcome Score as a Mortality Predictor in Isolated Moderate to Severe Traumatic Brain Injury: A...

Area of Science:

• Trauma Surgery
• Neurocritical Care
• Medical Informatics

Background:

• Traumatic brain injury (TBI) is a leading global cause of death and disability.
• Severe TBI cases are associated with increased complications and long-term mortality.
• The Geriatric Trauma Outcome Score (GTOS) is validated for predicting mortality in older trauma patients but not specifically for TBI.

Purpose of the Study:

• To evaluate the utility of the Geriatric Trauma Outcome Score (GTOS) in predicting in-hospital mortality for adult patients with isolated moderate to severe traumatic brain injury (TBI).
• To determine an optimal GTOS cutoff value for risk stratification in TBI patients.

Main Methods:

• Retrospective analysis of 5543 adult trauma patients with isolated moderate to severe TBI (head AIS ≥ 3) from 1998-2021.
• GTOS calculated using: age + (Injury Severity Score × 2.5) + 22 (if transfused within 24h).
• Area Under the Receiver Operating Characteristic Curve (AUROC) assessed predictive ability; Youden's index determined optimal cutoff; propensity score-matched analysis compared outcomes.

Main Results:

• Overall mortality was 8.3%. Higher mortality correlated with male sex, older age, higher GTOS, and comorbidities.
• The optimal GTOS cutoff for mortality prediction was 121.5 (AUROC = 0.813).
• Patients with GTOS ≥ 121.5 had significantly higher odds of death (OR 2.64) and longer hospital stays (16.7 vs. 12.2 days) compared to those with GTOS < 121.5, even after propensity score matching.

Conclusions:

• The Geriatric Trauma Outcome Score (GTOS) serves as a valuable tool for risk stratification of in-hospital mortality in moderate to severe TBI patients.
• Further research is recommended to refine the GTOS for enhanced applicability in TBI patient populations.