Assessing the Geriatric Trauma Outcome Score: A National Analysis

Abstract

Background

To assess the strength of the Geriatric Trauma Outcome Score (GTOS) in predicting mortality in geriatric trauma patients using a nationally representative sample.

Methods

Data from the National Trauma Data Bank were collected retrospectively from 2017 and 2018 for patients aged 65 and older (N = 487,317). Age, injury severity score (ISS), transfusion status, and hospital discharge status (survived vs deceased) were extracted. GTOS was then calculated for each patient. Simple logistic regression models were used to model hospital discharge status with GTOS and each component. Receiver-operating characteristic (ROC) curves were created using the predicted probabilities from the logistic models, and the area under the curve (AUC) for each model was calculated.

Results

Patients had a mean (SD) GTOS of 101.85 (19.53), age of 77.06 (7.20) years, and ISS of 9.75 (6.90). Very few (2%) patients had a blood transfusion within 24 hours of admission, and the overall survival rate was 96%. All models showed statistical significance in predicting discharge status (P < 0.0001) with AUCs of 0.5436 (age), 0.5727 (receipt of blood), 0.7979 (ISS), and 0.8145 (GTOS). When comparing models from each component to that of GTOS, GTOS remained more predictive than each individual component (P < 0.0001).

Discussion

After analyzing our models based on a nationally representative trauma data bank, GTOS predicted mortality better than each of its individual components. Therefore, GTOS is an appropriate tool to predict mortality among geriatric trauma patients and should be considered for applications such as informing goals-of-care or trauma transfer decision-making.