title: Early Predictors of Mortality in Geriatric Patients With Trauma.
abstract: OBJECTIVE
  To identify variables that predict mortality in geriatric patients with trauma.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  A total of 147 geriatric patients with trauma (age ≥65) with a predicted probability of survival of 10%-75% based on the Trauma Score-Injury Severity Score (TRISS).
  
  
  METHODS
  Patients were divided into 2 cohorts: survivors and nonsurvivors. The following variables available at presentation were analyzed: age, mechanism of injury, temperature, systolic blood pressure, pulse rate, shock index, respiratory rate, Glasgow Coma Scale (GCS) score, base deficit, and hematocrit (HCT). The Injury Severity Score (ISS) and TRISS were calculated for both cohorts.
  
  
  RESULTS
  Of the 147 patients analyzed, 84 (57%) died during the index hospitalization and 63 (43%) survived. The mean age of nonsurvivors was significantly higher than that of survivors (78.6 vs. 76.1 years; P < 0.04). A greater number of nonsurvivors (72.6%) sustained injuries as a result of a low-energy mechanism compared with survivors (54%; P = 0.02). GCS, temperature, and respiratory rate were significantly lower for nonsurvivors, whereas base deficit was higher (P < 0.05). The TRISS was predictive of survival (TRISS 0.27 vs. 0.53, P < 0.001), but the distinguishing capacity of the TRISS to predict mortality was limited (area under the receiver operator curve; 0.67; 95% confidence interval 0.58-0.76; P < 0.0001).
  
  
  CONCLUSIONS
  Older age, lower GCS, and a low-energy mechanism of injury are associated with a higher mortality rate in this at-risk geriatric trauma population. Early identification of predictors of mortality may help care providers more accurately assess injury burden in geriatric patients.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC; and †Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Wilson
authors.forename: Sanjit R
authors.initials: SR
authors.lastname: Konda
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Seymour
authors.forename: Madhav A
authors.initials: MA
authors.lastname: Karunakar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D005260:Female; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality*