Development of a Middle-Age and Geriatric Trauma Mortality Risk Score A Tool to Guide Palliative Care Consultations.
BACKGROUND
This study aimed to develop a tool to quantify risk of inpatient mortality among geriatric and middleaged trauma patients. This study sought to demonstrate the ability of the novel risk score in the early identification of high risk trauma patients for resource-sparing interventions, including referral to palliative medicine.


METHODS
This retrospective cohort study utilized data from a single level 1 trauma center. Regression analysis was used to create a novel risk of inpatient mortality score. A total of 2,387 low energy and 1,201 high-energy middle-aged (range: 55 to 64 years of age) and geriatric (65 years of age or odler) trauma patients comprised the study cohort. Model validation was performed using 37,474 lowenergy and 97,034 high-energy patients from the National Trauma Databank (NTDB). Potential hospital cost reduction was calculated for early referral of high risk trauma patients to palliative medicine services in comparison to no palliative medicine referral.


RESULTS
Factors predictive of inpatient mortality among the study and validation patient cohorts included; age, Glasgow Coma Scale, and Abbreviated Injury Scale for the head and neck and chest. Within the validation cohort, the novel mortality risk score demonstrated greater predictive capacity than existing trauma scores [STTGMALE-AUROC: 0.83 vs. TRISS 0.80, (p < 0.01), STTGMAHE-AUROC: 0.86 vs. TRISS 0.85, (p < 0.01)]. Our model demonstrated early palliative medicine evaluation could produce $1,083,082 in net hospital savings per year.


CONCLUSIONS
This novel risk score for older trauma patients has shown fidelity in prediction of inpatient mortality; in the study and validation cohorts. This tool may be used for early intervention in the care of patients at high risk of mortality and resource expenditure.
Sanjit R
SR
Konda
Rachel
R
Seymour
Arthur
A
Manoli
Jordan
J
Gales
Madhav A
MA
Karunakar
D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D015577:Geriatric Assessment; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D016017:Odds Ratio; D010166:Palliative Care / Q000191:economics; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014193:Trauma Centers; D014218:Triage; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000191:economics / Q000401:mortality* / Q000628:therapy