Mortality factors in geriatric blunt trauma patients: Creation of a highly predictive statistical model for mortality using 50,765 consecutive elderly trauma admissions from the national sample project

Tjasa Hranjec, Robert G. Sawyer, Jeffrey S. Young, Brian R. Swenson, James F. Calland

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Elderly patients are at high risk for mortality after injury. We hypothesized that trauma benchmarking efforts would benefit from development of a geriatric-specific model for risk-adjusted analyses of trauma center outcomes. A total of 57,973 records of elderly patients (age older than 65 years), which met our selection criteria, were submitted to the National Trauma Database and included within the National Sample Project between 2003 and 2006. These cases were used to construct a multivariable logistic regression model, which was compared with the American College of Surgeons Committee on Trauma's Trauma Quality Improvement Project's (TQIP) existing model. Additional spline regression analyses were performed to further objectively quantify the physiologic differences between geriatric patients and their younger counterparts. The geriatricspecific and TQIP mortality models shared several covariates: age, Injury Severity Score, motor component of the Glasgow Coma Scale, and systolic blood pressure. Our model additionally used temperature and the presence of mechanical ventilation. Our geriatric-specific regression mode generated a superior c-statistic as compared with the TQIP approximation (0.85 vs 0.77; P = 0.048). Spline analyses demonstrated that elderly patients appear to be less likely to tolerate relative hypotension with higher observed mortality at initial systolic blood pressures of 90 to 130 mmHg. Although the TQIP model includes a single age component, these data suggest that each variable needs to be adjusted for age to more accurately predict mortality in the elderly. Clearly, a separate geriatric model for predicting outcomes is not only warranted, but necessary.

Original languageEnglish (US)
Pages (from-to)1369-1375
Number of pages7
JournalAmerican Surgeon
Volume78
Issue number12
StatePublished - Dec 2012

Fingerprint

Statistical Models
Geriatrics
Mortality
Wounds and Injuries
Quality Improvement
Blood Pressure
Logistic Models
Benchmarking
Glasgow Coma Scale
Injury Severity Score
Trauma Centers
Artificial Respiration
Hypotension
Patient Selection
Regression Analysis
Databases
Temperature

ASJC Scopus subject areas

  • Surgery

Cite this

Mortality factors in geriatric blunt trauma patients : Creation of a highly predictive statistical model for mortality using 50,765 consecutive elderly trauma admissions from the national sample project. / Hranjec, Tjasa; Sawyer, Robert G.; Young, Jeffrey S.; Swenson, Brian R.; Calland, James F.

In: American Surgeon, Vol. 78, No. 12, 12.2012, p. 1369-1375.

Research output: Contribution to journalArticle

@article{aceed339fa924ebd9f35bce394f59620,
title = "Mortality factors in geriatric blunt trauma patients: Creation of a highly predictive statistical model for mortality using 50,765 consecutive elderly trauma admissions from the national sample project",
abstract = "Elderly patients are at high risk for mortality after injury. We hypothesized that trauma benchmarking efforts would benefit from development of a geriatric-specific model for risk-adjusted analyses of trauma center outcomes. A total of 57,973 records of elderly patients (age older than 65 years), which met our selection criteria, were submitted to the National Trauma Database and included within the National Sample Project between 2003 and 2006. These cases were used to construct a multivariable logistic regression model, which was compared with the American College of Surgeons Committee on Trauma's Trauma Quality Improvement Project's (TQIP) existing model. Additional spline regression analyses were performed to further objectively quantify the physiologic differences between geriatric patients and their younger counterparts. The geriatricspecific and TQIP mortality models shared several covariates: age, Injury Severity Score, motor component of the Glasgow Coma Scale, and systolic blood pressure. Our model additionally used temperature and the presence of mechanical ventilation. Our geriatric-specific regression mode generated a superior c-statistic as compared with the TQIP approximation (0.85 vs 0.77; P = 0.048). Spline analyses demonstrated that elderly patients appear to be less likely to tolerate relative hypotension with higher observed mortality at initial systolic blood pressures of 90 to 130 mmHg. Although the TQIP model includes a single age component, these data suggest that each variable needs to be adjusted for age to more accurately predict mortality in the elderly. Clearly, a separate geriatric model for predicting outcomes is not only warranted, but necessary.",
author = "Tjasa Hranjec and Sawyer, {Robert G.} and Young, {Jeffrey S.} and Swenson, {Brian R.} and Calland, {James F.}",
year = "2012",
month = "12",
language = "English (US)",
volume = "78",
pages = "1369--1375",
journal = "American Surgeon",
issn = "0003-1348",
publisher = "Southeastern Surgical Congress",
number = "12",

}

TY - JOUR

T1 - Mortality factors in geriatric blunt trauma patients

T2 - Creation of a highly predictive statistical model for mortality using 50,765 consecutive elderly trauma admissions from the national sample project

AU - Hranjec, Tjasa

AU - Sawyer, Robert G.

AU - Young, Jeffrey S.

AU - Swenson, Brian R.

AU - Calland, James F.

PY - 2012/12

Y1 - 2012/12

N2 - Elderly patients are at high risk for mortality after injury. We hypothesized that trauma benchmarking efforts would benefit from development of a geriatric-specific model for risk-adjusted analyses of trauma center outcomes. A total of 57,973 records of elderly patients (age older than 65 years), which met our selection criteria, were submitted to the National Trauma Database and included within the National Sample Project between 2003 and 2006. These cases were used to construct a multivariable logistic regression model, which was compared with the American College of Surgeons Committee on Trauma's Trauma Quality Improvement Project's (TQIP) existing model. Additional spline regression analyses were performed to further objectively quantify the physiologic differences between geriatric patients and their younger counterparts. The geriatricspecific and TQIP mortality models shared several covariates: age, Injury Severity Score, motor component of the Glasgow Coma Scale, and systolic blood pressure. Our model additionally used temperature and the presence of mechanical ventilation. Our geriatric-specific regression mode generated a superior c-statistic as compared with the TQIP approximation (0.85 vs 0.77; P = 0.048). Spline analyses demonstrated that elderly patients appear to be less likely to tolerate relative hypotension with higher observed mortality at initial systolic blood pressures of 90 to 130 mmHg. Although the TQIP model includes a single age component, these data suggest that each variable needs to be adjusted for age to more accurately predict mortality in the elderly. Clearly, a separate geriatric model for predicting outcomes is not only warranted, but necessary.

AB - Elderly patients are at high risk for mortality after injury. We hypothesized that trauma benchmarking efforts would benefit from development of a geriatric-specific model for risk-adjusted analyses of trauma center outcomes. A total of 57,973 records of elderly patients (age older than 65 years), which met our selection criteria, were submitted to the National Trauma Database and included within the National Sample Project between 2003 and 2006. These cases were used to construct a multivariable logistic regression model, which was compared with the American College of Surgeons Committee on Trauma's Trauma Quality Improvement Project's (TQIP) existing model. Additional spline regression analyses were performed to further objectively quantify the physiologic differences between geriatric patients and their younger counterparts. The geriatricspecific and TQIP mortality models shared several covariates: age, Injury Severity Score, motor component of the Glasgow Coma Scale, and systolic blood pressure. Our model additionally used temperature and the presence of mechanical ventilation. Our geriatric-specific regression mode generated a superior c-statistic as compared with the TQIP approximation (0.85 vs 0.77; P = 0.048). Spline analyses demonstrated that elderly patients appear to be less likely to tolerate relative hypotension with higher observed mortality at initial systolic blood pressures of 90 to 130 mmHg. Although the TQIP model includes a single age component, these data suggest that each variable needs to be adjusted for age to more accurately predict mortality in the elderly. Clearly, a separate geriatric model for predicting outcomes is not only warranted, but necessary.

UR - http://www.scopus.com/inward/record.url?scp=84871068720&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871068720&partnerID=8YFLogxK

M3 - Article

C2 - 23265126

AN - SCOPUS:84871068720

VL - 78

SP - 1369

EP - 1375

JO - American Surgeon

JF - American Surgeon

SN - 0003-1348

IS - 12

ER -