Mechanism of Injury Differentiates Risk Factors for Mortality in Geriatric Trauma Patients.

Abstract:

OBJECTIVES:To evaluate the relationship between mechanism of injury and mortality in geriatric trauma patients and the ability of existing injury severity indices (ISIs) to assess mortality. DESIGN:Retrospective review. SETTING:Urban level 1 trauma center. PARTICIPANTS:Four thousand five hundred forty-five trauma patients age ≥55 presenting between 2008 and 2011. INTERVENTION:Low-energy (LE-GTP) and high-energy (HE-GTP) geriatric trauma patient cohorts were created based on ICD-9 injury codes. Existing ISIs were evaluated for their ability to predict in-hospital mortality using the area under the receiver-operating characteristic curve (AUROC). MAIN OUTCOME MEASURES:Mortality. RESULTS:The Trauma Score-Injury Severity Score (TRISS) was the most predictive ISI for both cohorts and was deemed to have moderate predictive capacity (AUROC: 0.82) in LE-GTP and excellent predictive capacity (AUROC: 0.91) in the HE-GTP. For, HE-GTP each 1-year increase in age was associated with a 12% increase risk of mortality versus 6% for LE-GTP. Preexisting conditions (PECs) were distributed differently between the cohorts with significantly more PECs in the LE-GTP (P < 0.01). CONCLUSIONS:Existing ISIs have fair-to-moderate predictive capacity for in-hospital morality in LE-GTPs and moderate-to-excellent predictive capacity in HE-GTPs. LE-GTPs and HE-GTPs are distinct cohorts that should be evaluated separately. Combining the cohorts underestimates both the effect of age on HE-GTPs and the effect of PECs on LE-GTPs while overestimating the effect of PECs on HE-GTPs. LEVEL OF EVIDENCE:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

journal_name

J Orthop Trauma

authors

Konda SR,Lack WD,Seymour RB,Karunakar MA

doi

10.1097/BOT.0000000000000281

subject

Has Abstract

pub_date

2015-07-01 00:00:00

pages

331-6

issue

7

eissn

0890-5339

issn

1531-2291

pii

00005131-201507000-00009

journal_volume

29

pub_type

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