The GERtality Score: The Development of a Simple Tool to Help Predict in-Hospital Mortality in Geriatric Trauma Patients.

Julian Scherer,Kai Oliver Jensen,Franziska Ziegenhain,Kai Sprengel,Hans-Christoph Pape,Rolf Lefering,Valentin Neuhaus,Michel Teuben,Yannik Kalbas

doi:10.3390/jcm10071362

Julian Scherer, Kai Oliver Jensen + Show 7 more

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https://doi.org/10.3390/jcm10071362

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Abstract

Feasible and predictive scoring systems for severely injured geriatric patients are lacking. Therefore, the aim of this study was to develop a scoring system for the prediction of in-hospital mortality in severely injured geriatric trauma patients. The TraumaRegister DGU® (TR-DGU) was utilized. European geriatric patients (≥65 years) admitted between 2008 and 2017 were included. Relevant patient variables were implemented in the GERtality score. By conducting a receiver operating characteristic (ROC) analysis, a comparison with the Geriatric Trauma Outcome Score (GTOS) and the Revised Injury Severity Classification II (RISC-II) Score was performed. A total of 58,055 geriatric trauma patients (mean age: 77 years) were included. Univariable analysis led to the following variables: age ≥ 80 years, need for packed red blood cells (PRBC) transfusion prior to intensive care unit (ICU), American Society of Anesthesiologists (ASA) score ≥ 3, Glasgow Coma Scale (GCS) ≤ 13, Abbreviated Injury Scale (AIS) in any body region ≥ 4. The maximum GERtality score was 5 points. A mortality rate of 72.4% was calculated in patients with the maximum GERtality score. Mortality rates of 65.1 and 47.5% were encountered in patients with GERtality scores of 4 and 3 points, respectively. The area under the curve (AUC) of the novel GERtality score was 0.803 (GTOS: 0.784; RISC-II: 0.879). The novel GERtality score is a simple and feasible score that enables an adequate prediction of the probability of mortality in polytraumatized geriatric patients by using only five specific parameters.

Highlights

Several successful trauma outcome scores have been developed in the last few Trauma scoring systems are important instruments for the optimization of clinical decision making, the determination of outcome and the standardization of clinical studies [15,16]
Several successful trauma outcome scores have been developed in the last few decades, such as the Trauma Injury Severity Score (TRISS), APACHE-II-Score, Revised
Only two scoring systems were explicitly developed for mortality prediction after trauma in the geriatric population: namely, the new Geriatric Trauma Outcome Score (GTOS) and the very recently published Elderly Mortality after Trauma Score (EMAT) [21]

Summary

Introduction

The elderly population increases worldwide and subsequently the number of geriatric trauma patients rises as well [1]. Geriatric patients require special medical attention due to the higher risks for mortality and morbidity related to frailty, reduced physiological compensation mechanisms after trauma, polypharmacy and preexisting comorbidities, both in high-energy trauma cases as well as in low-energy trauma situations [2,3,4,5,6]. Prediction-model based outcome scores are useful tools for judging patients’ status and to guide medical decision making. In trauma, there is a need for adequate (mortality) prediction models to optimize post-resuscitation triage and the determination of initial therapy until transfer to the intensive care unit (ICU) in severely injured patients. Several trauma outcome scores have been developed in which patients’ age is addressed

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