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

Abstract

Purpose The 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. Methods Annual 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. Results The 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. Conclusion The 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.

Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries

“…This AUC was close to the value published by Wu et al of 0.892 [29]. Opposing our results, other studies found a possible superiority of the ISS, NISS and TRISS over the APACHE II for geriatric polytraumatized patients [30]. This demonstrates that the predictive quality of a scoring system depends on the underlying patient population.…”

Prognostic value of APACHE II and SAVE scores in adult patients treated with extracorporeal cardiopulmonary resuscitation

“…APACHE II score has been widely used to evaluate and predict the prognosis of various types of critically ill patients [12][13][14][15] According to our study, we recommend that the combination of APACHE II and SAVE scores could be used to predict prognosis in adult patients with ECPR considering the different emphases of the two scoring systems. Given the high cost [20], the frequent and fatal complications of ECMO and the uncertainty of outcome, it is of great necessity for us to conduct a detailed evaluation of patients to maximize the bene ts of ECMO.…”

Beyond mortality: Does trauma-related injury severity score predict complications or lengths of stay using a large administrative dataset

“…TRISS has been well validated in predicting mortality over many years and similar to previously published results, TRISS appears to be a superior predictor of mortality when measured against ISS, RTS, GCS, APACHE II, or age. [ 13 14 ] Other scoring systems have been studied for their predictive value on LOS and quality of life. These studies, however, have been limited to specific populations such as traumatic brain injuries.…”

“…According to Jiang et al ., TRISS has been shown to be an effective scoring system for geriatrics in-hospital mortality. [ 14 ] Various alternative models such as Index of Coexistent Comorbidity Disease and TRISSCOM (TRISS in the presence of comorbidities) have shown that the significant spike in comorbidities over the age of 65, does in fact impact the way TRISS is used to determine morbidity and mortality. [ 19 20 ] Being able to incorporate models that can clearly tie in such cofounders would be a great asset in enhancing the predictive potential of TRISS.…”