title: A simple clinical risk nomogram to predict mortality-associated geriatric complications in severely injured geriatric patients.
abstract: BACKGROUND
  This study aimed to (1) identify inpatient complications associated with the greatest differential mortality risk between young and old patients with traumatic injury and (2) identify older patients at elevated risk for mortality-associated complications.
  
  
  METHODS
  Secondary analysis of more than 280,000 patients hospitalized for traumatic injury in 2001 to 2005 collected by the National Trauma Data Bank was performed. Predictor variables include 21 hospital complications. We used each complication to predict odds of hospital mortality, stratified by old (65+ years) versus young (18-64 years) age, controlling for age, sex, and preexisting condition count. We defined mortality-associated geriatric complications (MGCs) as complications associated with more than two times risk of mortality in older patients compared with younger patients. We then used age, comorbidity, and sex to predict development of MGCs or death.
  
  
  RESULTS
  We defined seven infectious and six noninfectious complications as MGCs (adjusted relative risk reduction for death associated with old age [aRRR] with 95% confidence interval [CI]): abscess (aRRR, 4.1; 95% CI, 3.6-4.5), wound infection (aRRR, 3.5; 95% CI, 3.2-3.9), empyema (aRRR, 3.4; 95% CI, 3.1, 3.8), urinary tract infection (aRRR, 3.3; 95% 3.0-3.6), pneumonia (aRRR, 3.1; 95% CI, 2.8-3.5), bacteremia (aRRR, 2.8; 95% CI, 2.6-3.0), aspiration pneumonia (aRRR, 2.6; 95% CI, 2.2-3.0), reduction/fixation failure (aRRR, 3.6; 95% CI, 3.3-3.9), pressure ulcer (aRRR, 3.3; 95% CI, 3.1-3.6), deep venous thrombosis (aRRR, 3.2; 95% CI, 2.9-3.6), pneumothorax (aRRR, 3.1; 95% CI, 2.5-3.7), and compartment syndrome (aRRR, 2.2; 95% CI, 1.5-2.9). We developed a graphical nomogram based on sex, age, and number of preexisting conditions to predict risk of MGCs (c statistic, 0.74).
  
  
  CONCLUSIONS
  Older patients at risk for MGC development should be considered for targeted interventions to improve quality of care.
  
  
  METHODS
  Prognostic/epidemiologic study, level III.
authors.affiliation: Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA. lmin@med.umich.edu
authors.forename: Lillian
authors.initials: L
authors.lastname: Min
authors.forename: Sigrid
authors.initials: S
authors.lastname: Burruss
authors.forename: Eric
authors.initials: E
authors.lastname: Morley
authors.forename: Lona
authors.initials: L
authors.lastname: Mody
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: Henry
authors.initials: H
authors.lastname: Cryer
authors.forename: Jin-Kyung
authors.initials: JK
authors.lastname: Ha
authors.forename: Areti
authors.initials: A
authors.lastname: Tillou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011014:Pneumonia / Q000401:mortality*; D003668:Pressure Ulcer / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000592:standards*; D012307:Risk Factors; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000401:mortality*; D020246:Venous Thrombosis / Q000401:mortality*; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult