title: Predicting In-Hospital and 1-Year Mortality in Geriatric Trauma Patients Using Geriatric Trauma Outcome Score.
abstract: BACKGROUND
  The Geriatric Trauma Outcome Score (GTOS; [age] + [2.5 × Injury Severity Score] + 22 [if packed RBC transfused within ≤24 hours of admission]), was developed and validated as a prognostic indicator for in-hospital mortality in elderly trauma patients. However, GTOS neither provides information about post-discharge outcomes nor discriminates between patients dying with and without care restrictions. Isolating the latter, GTOS prediction performance was examined during admission and 1-year post discharge in a mature European trauma registry.
  
  
  METHODS
  All trauma admissions 65 years of age and older in a university hospital during 2007 to 2011 were considered. Data on age, Injury Severity Score, packed RBC transfusion within ≤24 hours, therapy restrictions, discharge disposition, and mortality were collected. In-hospital deaths with therapy restrictions and patients discharged to hospice were excluded. The GTOS was the sole predictor in a logistic regression model estimating mortality probabilities. Performance of the model was assessed by misclassification rate, Brier score, Tjur R2, and area under the curve.
  
  
  RESULTS
  The study population was 1,080 patients with a median age of 75 years, mean Injury Severity Score of 10, and packed RBCs transfused in 8.2%. In-hospital mortality was 14.9% and 7.7% after exclusions. Misclassification rate fell from 14% to 6.5% and Brier score from 0.09 to 0.05, and area under the curve increased from 0.87 to 0.88. Equivalent values for the original GTOS sample were 9.8%, 0.07, and 0.82, respectively. One-year mortality follow-up showed a misclassification rate of 17.6% and Brier score of 0.13.
  
  
  CONCLUSIONS
  Excluding patients with care restrictions and discharged to hospice improved GTOS performance for in-hospital mortality prediction. The GTOS is not adept at predicting 1-year mortality.
authors.affiliation: School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Rebecka
authors.initials: R
authors.lastname: Ahl
authors.affiliation: UT-Southwestern Medical Center-Parkland Memorial Hospital, Dallas, TX.
authors.forename: Herb A
authors.initials: HA
authors.lastname: Phelan
authors.affiliation: Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
authors.forename: Sinan
authors.initials: S
authors.lastname: Dogan
authors.affiliation: School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden; Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Yang
authors.initials: Y
authors.lastname: Cao
authors.affiliation: UT-Southwestern Medical Center-Parkland Memorial Hospital, Dallas, TX.
authors.forename: Allyson C
authors.initials: AC
authors.lastname: Cook
authors.affiliation: School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden; Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden. Electronic address: mohsenishahin@yahoo.com.
authors.forename: Shahin
authors.initials: S
authors.lastname: Mohseni
mesh_terms: D000368:Aged; D017707:Erythrocyte Transfusion; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012042:Registries; D013548:Sweden; D014947:Wounds and Injuries / Q000401:mortality*