The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients

Libing Jiang,Mao Zhang,Zhongjun Zheng

doi:10.1186/s13017-020-00340-1

Abstract

PurposeThe study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients.MethodsAnnual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level I trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated.ResultsThe analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE II, and SAPS II in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715, and 0.725, respectively.ConclusionThe total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.

Highlights

Trauma is the fourth leading cause of death overall for all ages and the leading cause of death among young people aged less than 45 years [1]
The incidence of geriatric trauma is increasing The analysis of the National Trauma Database (NTDB) showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015
The results showed that men had a significantly higher mortality rate than women in geriatric trauma patients (Fig. 1b)

Summary

Introduction

Trauma is the fourth leading cause of death overall for all ages and the leading cause of death among young people aged less than 45 years [1]. Along with the aging population, geriatric trauma is rapidly becoming a major public health concern [3]. A growing number of countries have pay attention to these populations, and some researchers even suggested it is necessary to build specific geriatric trauma centers [9,10,11]. There is lack of convincing evidence that the incidence of geriatric trauma is increasing. Accurate prognosis assessment is important for clinical decision-making in geriatric trauma patients [12,13,14]. A number of injury severity measures are developed for the purpose of outcome prediction [15], but few are validated in the geriatric trauma population. The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II) and SAPS II (simplified acute physiology score II) for the prediction of in-hospital mortality in geriatric trauma patients

Methods

Results

Discussion

Conclusion