Evaluation of the revised trauma and injury severity scores in elderly trauma patients

Abstract

Background:Severity-of-illness scoring systems have primarily been developed for, and validated in, younger trauma patients.Aims:We sought to determine the accuracy of the injury severity score (ISS) and the revised trauma score (RTS) in predicting mortality and hospital length of stay (LOS) in trauma patients over the age of 65 treated in our emergency department (ED).Materials and Methods:Using the Illinois Trauma Registry, we identified all patients 65 years and older treated in our level I trauma facility from January 2004 to November 2007. The primary outcome was death; the secondary outcome was overall hospital length of stay (LOS). We measured associations between scores and outcomes with binary logistic and linear regression.Results:A total of 347 patients, 65 years of age and older were treated in our hospital during the study period. Median age was 76 years (IQR 69-82), with median ISS 13 (IQR 8-17), and median RTS 7.8 (IQR 7.1-7.8). Overall mortality was 24%. A higher value for ISS showed a positive correlation with likelihood of death, which although statistically significant, was numerically small (OR=1.10, 95% CI 1.06 to 1.13, P<0.001). An elevated RTS had an inverse correlation to likelihood of death that was also statistically significant (OR=0.48, 95% CI 0.39 to 0.58, P<0.001). Total hospital LOS increased with increasing ISS, with statistical significance decreasing at the highest levels of ISS, but an increase in RTS not confirming the predicted decrease in total hospital LOS consistently across all ranges of RTS.Conclusions:The ISS and the RTS were better predictors of mortality than hypothesized, but had limited correlation with hospital LOS in elderly trauma patients. Although there may be some utility in these scores when applied to the elderly population, caution is warranted if attempting to predict the prognosis of patients.

Predictors of early versus late mortality in pelvic trauma patients

“…RTS is calculated based on patient GCS, blood pressure, and respiratory rate, which are closely related to hemodynamic stability. We therefore conclude this to be an accurate predictor of early mortality [ 14 , 33 ]. ISS is determined by associated injuries and is calculated utilizing an abbreviated injury scale in each of the 6 body regions which summarizes the patient’s general condition in addition to the severity of the injuries within each region [ 34 ].…”

“…Several North American studies have asserted other in-hospital mortality predictors among pelvic trauma patients, such as low initial hemoglobin and direct transfer to the operating room (OR) [ 7 – 12 ]. Regardless of different risks predicting in-hospital mortality in pelvic trauma patients, the most common independent risk factor in the literature is severity of injuries as determined via revised trauma score (RTS) and injury severity score (ISS) systems [ 13 , 14 ].…”

Sex Disparities in Elderly Trauma in Northern Iran

“…We observed that in the present study, the number of men was more than women. Watts et al have shown that injured men (56%) are more than injured women (44%) (18). Such results also were seen in other studies (16,19,27,(30)(31)(32) The high number of trauma cases in men may be justified according to employment status, family role and responsibility, the presence of men outdoors, and motor vehicle usage.…”

“…O'Neill et al reported it too be 9.1% (23). In various studies, there are inconsistent statistics (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Age has been shown to be an independent predictor of mortality following trauma, and care for the elderly trauma patients is characterized by increased costs due to longer hospital stays and increased complication rates (28,29).…”

“…The results of the studies about the effects of gender on the outcomes of trauma were controversial. A study has shown that the injuries, fractures and, hospitalization rates in women were more than those in men (17), while another study has shown higher injuries in men compared to women (18). Another study has stated that the outcome of the accident is the same in elderly men and women (19).…”