[Age and survival likelihood of polytrauma patients. "Local tailoring" of the DGU prognosis model].
BACKGROUND
Age is one of five prognostic parameters identified based on data of the trauma registry of the German Association for Trauma Surgery (DGU). We asked ourselves if the suggested prognostic model provides the same predictive power of data from an independent hospital. Furthermore, we investigated whether age itself or age-associated comorbidity causes an unfavorable prognostic effect.


METHODS
The investigation was based on data of 103 multiply injured patients (67 male, 36 female, mean age 35,4+/-SD 19,0 years, ISS 36,8+/-10,9). Data were collected prospectively following the guidelines of the trauma registry of the German Association for Trauma Surgery. Based on documented comorbidities, a risk calculation was performed using the ASA classification. Correlation between age and ASA was analyzed using Spearman's method. The prognostic value of the original model in our patient pool with or without ASA classification, possible interactions, and the discriminatory power of the model were estimated using logistic regression.


RESULTS
Attributable mortality was 31,7% (95% CI 22,7-41,7%). Age, ISS, GCS and ASA were included into the final logistic model. Odds ratios of the origin model were reproducible nearly identical in our patinet pool (OR: age 1,048; ISS 1,066; GCS 0,822). In spite of the fact that we have found a strong correlation between age and ASA-Classification (rho=0,60, p<0,0001) there was no prognostic value of comorbidity.


CONCLUSIONS
The suggested prognostic model based on multicenter data evaluation can be applied to a single center with only minimal loss of discriminatory power. In this context, age seems to have a prognostic value independent of comorbidity.
Matthes
G
G
Abteilung für Unfallchirurgie, Klinik und Poliklinik für Chirurgie, Ernst-Moritz-Arndt-Universität, Greifswald. gerrit.matthes@uni-greifswald.de
Seifert
J
J
Bogatzki
S
S
Steinhage
K
K
Ekkernkamp
A
A
Stengel
D
D
D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis* / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D015599:Trauma Severity Indices