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Multi-outcome prognostic modelling for older adults after trauma: development and validation of the Older Trauma
Mayura Iddagoda1,2, Michelle Trevenen1, Dieter G Weber3,4
1School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
Background:
Older adults account for a rising proportion of trauma admissions, yet most prognostic tools for this group predict mortality alone. A validated multi-outcome model could support early risk stratification and optimize trauma care planning. This study developed and validated the Older Trauma Outcome Prediction (OTOP) model, the first tool designed to estimate multiple inpatient outcomes in older trauma patients.
Methods:
This study used Western Australia Trauma Registry linked data on patients aged ≥ 50 years admitted after external injury (2000-2020). Predictor variables, identified from a systematic review, included demographic factors, co-morbidities, injury characteristics, physiological measurements, and resuscitation indicators. The cohort was randomly divided into training (80%) and validation (20%) sets. Ridge logistic regression was used for binary outcomes (in-hospital mortality, surgery, intensive care unit (ICU) admission, medical complications), multinomial logistic regression was used for discharge destination, and quasi-Poisson regression was used for hospital length of stay. Model performance was assessed using the area under the curve (AUC), calibration, and error metrics.
Results:
This study analysed 105 972 trauma admissions aged ≥ 50 years between 2000 and 2020 (84 778 patients in the training cohort, 21 194 in the validation cohort). The mean age of all patients was 74.0 years, and 45.3% were men. Mortality prediction showed excellent discrimination (AUC 0.95), outperforming the Geriatric Trauma Outcome Score (AUC 0.83). The surgery and ICU admission models performed well (AUC 0.97 and 0.96, respectively). Length-of-hospital-stay prediction demonstrated moderate accuracy (mean absolute error 4.9 days), whereas prediction of medical complications was limited (AUC 0.60). Discharge destination was accurately classified into home, rehabilitation, residential care, or death.
Conclusion:
OTOP is the first validated multi-outcome prognostic model for older trauma patients, providing accurate and clinically relevant predictions to support early decision-making and optimize trauma system resource use.
