Multicenter External Validation of the Geriatric Trauma Outcome Score: A Study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly [PALLIATE] Consortium

Allyson C. Cook, Bellal Joseph, Kenji Inaba, Paul A. Nakonezny, Brandon R. Bruns, Jeff D. Kerby, Karen J. Brasel, Steve E. Wolf, Joe Cuschieri, M. Elizabeth Paulk, Ramona L. Rhodes, Scott C. Brakenridge, Herb A. Phelan

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Abstract

BACKGROUND: A prognostic tool for geriatric mortality after injury called the “Geriatric Trauma Outcome Score” (GTOS), where GTOS = [age] + [ISS x 2.5] + [22 if transfused any PRBCs by 24 hours after admission], was previously developed based on 13 years of data from geriatric trauma patients admitted to Parkland Hospital. We sought to validate the model. METHODS: Four level I centers identified subjects ≥65 years for the period of the original study. The GTOS model was first specified using the formula [GTOS= age + (ISS x 2.5) + 22(if given PRBC by 24 hours)] developed from the Parkland sample, then used as the sole predictor in a logistic mixed model estimating probability of mortality in the validation sample, accounting for site as a random effect. We estimated the misclassification (error) rate, Brier score, Tjur R-square, and AUC in evaluating the predictive performance of the GTOS model. RESULTS: The original Parkland sample (n=3,841) was mean age=76.6 years (SD±8.1); mean ISS=12.4 (SD±9.9); mortality=10.8%; and 11.9% received PRBCs at 24 hours. The validation sample (n=18,282) was mean age=77.0 years (SD+8.1); mean ISS=12.3 (SD+10.6); mortality=11.0%; and 14.1% received PRBCs at 24 hours. Fitting the GTOS model to the validation sample revealed that the parameter estimates from the validation sample were similar to those of fitting it to the Parkland sample with highly overlapping 95% confidence limits. The misclassification (error) rate for the GTOS logistic model applied to the validation sample was 9.97%, similar to that of the Parkland sample (9.79%). Brier score, Tjur R-square, and AUC for the GTOS logistic model when applied to the validation sample were 0.07, 0.25, and 0.86, respectively, compared with 0.08, 0.20, and 0.82, respectively, for the Parkland sample. CONCLUSION: Utilizing data available at 24 hours post-injury, the GTOS accurately predicts in-hospital mortality for the injured elderly. LEVEL OF EVIDENCE: III STUDY TYPE: Prognostic

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - Nov 21 2015

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Geriatrics
Wounds and Injuries
Injury Severity Score
Mortality
Logistic Models
Area Under Curve
Hospital Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Multicenter External Validation of the Geriatric Trauma Outcome Score : A Study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly [PALLIATE] Consortium. / Cook, Allyson C.; Joseph, Bellal; Inaba, Kenji; Nakonezny, Paul A.; Bruns, Brandon R.; Kerby, Jeff D.; Brasel, Karen J.; Wolf, Steve E.; Cuschieri, Joe; Elizabeth Paulk, M.; Rhodes, Ramona L.; Brakenridge, Scott C.; Phelan, Herb A.

In: Journal of Trauma and Acute Care Surgery, 21.11.2015.

Research output: Contribution to journalArticle

Cook, Allyson C. ; Joseph, Bellal ; Inaba, Kenji ; Nakonezny, Paul A. ; Bruns, Brandon R. ; Kerby, Jeff D. ; Brasel, Karen J. ; Wolf, Steve E. ; Cuschieri, Joe ; Elizabeth Paulk, M. ; Rhodes, Ramona L. ; Brakenridge, Scott C. ; Phelan, Herb A. / Multicenter External Validation of the Geriatric Trauma Outcome Score : A Study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly [PALLIATE] Consortium. In: Journal of Trauma and Acute Care Surgery. 2015.
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title = "Multicenter External Validation of the Geriatric Trauma Outcome Score: A Study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly [PALLIATE] Consortium",
abstract = "BACKGROUND: A prognostic tool for geriatric mortality after injury called the “Geriatric Trauma Outcome Score” (GTOS), where GTOS = [age] + [ISS x 2.5] + [22 if transfused any PRBCs by 24 hours after admission], was previously developed based on 13 years of data from geriatric trauma patients admitted to Parkland Hospital. We sought to validate the model. METHODS: Four level I centers identified subjects ≥65 years for the period of the original study. The GTOS model was first specified using the formula [GTOS= age + (ISS x 2.5) + 22(if given PRBC by 24 hours)] developed from the Parkland sample, then used as the sole predictor in a logistic mixed model estimating probability of mortality in the validation sample, accounting for site as a random effect. We estimated the misclassification (error) rate, Brier score, Tjur R-square, and AUC in evaluating the predictive performance of the GTOS model. RESULTS: The original Parkland sample (n=3,841) was mean age=76.6 years (SD±8.1); mean ISS=12.4 (SD±9.9); mortality=10.8{\%}; and 11.9{\%} received PRBCs at 24 hours. The validation sample (n=18,282) was mean age=77.0 years (SD+8.1); mean ISS=12.3 (SD+10.6); mortality=11.0{\%}; and 14.1{\%} received PRBCs at 24 hours. Fitting the GTOS model to the validation sample revealed that the parameter estimates from the validation sample were similar to those of fitting it to the Parkland sample with highly overlapping 95{\%} confidence limits. The misclassification (error) rate for the GTOS logistic model applied to the validation sample was 9.97{\%}, similar to that of the Parkland sample (9.79{\%}). Brier score, Tjur R-square, and AUC for the GTOS logistic model when applied to the validation sample were 0.07, 0.25, and 0.86, respectively, compared with 0.08, 0.20, and 0.82, respectively, for the Parkland sample. CONCLUSION: Utilizing data available at 24 hours post-injury, the GTOS accurately predicts in-hospital mortality for the injured elderly. LEVEL OF EVIDENCE: III STUDY TYPE: Prognostic",
author = "Cook, {Allyson C.} and Bellal Joseph and Kenji Inaba and Nakonezny, {Paul A.} and Bruns, {Brandon R.} and Kerby, {Jeff D.} and Brasel, {Karen J.} and Wolf, {Steve E.} and Joe Cuschieri and {Elizabeth Paulk}, M. and Rhodes, {Ramona L.} and Brakenridge, {Scott C.} and Phelan, {Herb A.}",
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T2 - A Study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly [PALLIATE] Consortium

AU - Cook, Allyson C.

AU - Joseph, Bellal

AU - Inaba, Kenji

AU - Nakonezny, Paul A.

AU - Bruns, Brandon R.

AU - Kerby, Jeff D.

AU - Brasel, Karen J.

AU - Wolf, Steve E.

AU - Cuschieri, Joe

AU - Elizabeth Paulk, M.

AU - Rhodes, Ramona L.

AU - Brakenridge, Scott C.

AU - Phelan, Herb A.

PY - 2015/11/21

Y1 - 2015/11/21

N2 - BACKGROUND: A prognostic tool for geriatric mortality after injury called the “Geriatric Trauma Outcome Score” (GTOS), where GTOS = [age] + [ISS x 2.5] + [22 if transfused any PRBCs by 24 hours after admission], was previously developed based on 13 years of data from geriatric trauma patients admitted to Parkland Hospital. We sought to validate the model. METHODS: Four level I centers identified subjects ≥65 years for the period of the original study. The GTOS model was first specified using the formula [GTOS= age + (ISS x 2.5) + 22(if given PRBC by 24 hours)] developed from the Parkland sample, then used as the sole predictor in a logistic mixed model estimating probability of mortality in the validation sample, accounting for site as a random effect. We estimated the misclassification (error) rate, Brier score, Tjur R-square, and AUC in evaluating the predictive performance of the GTOS model. RESULTS: The original Parkland sample (n=3,841) was mean age=76.6 years (SD±8.1); mean ISS=12.4 (SD±9.9); mortality=10.8%; and 11.9% received PRBCs at 24 hours. The validation sample (n=18,282) was mean age=77.0 years (SD+8.1); mean ISS=12.3 (SD+10.6); mortality=11.0%; and 14.1% received PRBCs at 24 hours. Fitting the GTOS model to the validation sample revealed that the parameter estimates from the validation sample were similar to those of fitting it to the Parkland sample with highly overlapping 95% confidence limits. The misclassification (error) rate for the GTOS logistic model applied to the validation sample was 9.97%, similar to that of the Parkland sample (9.79%). Brier score, Tjur R-square, and AUC for the GTOS logistic model when applied to the validation sample were 0.07, 0.25, and 0.86, respectively, compared with 0.08, 0.20, and 0.82, respectively, for the Parkland sample. CONCLUSION: Utilizing data available at 24 hours post-injury, the GTOS accurately predicts in-hospital mortality for the injured elderly. LEVEL OF EVIDENCE: III STUDY TYPE: Prognostic

AB - BACKGROUND: A prognostic tool for geriatric mortality after injury called the “Geriatric Trauma Outcome Score” (GTOS), where GTOS = [age] + [ISS x 2.5] + [22 if transfused any PRBCs by 24 hours after admission], was previously developed based on 13 years of data from geriatric trauma patients admitted to Parkland Hospital. We sought to validate the model. METHODS: Four level I centers identified subjects ≥65 years for the period of the original study. The GTOS model was first specified using the formula [GTOS= age + (ISS x 2.5) + 22(if given PRBC by 24 hours)] developed from the Parkland sample, then used as the sole predictor in a logistic mixed model estimating probability of mortality in the validation sample, accounting for site as a random effect. We estimated the misclassification (error) rate, Brier score, Tjur R-square, and AUC in evaluating the predictive performance of the GTOS model. RESULTS: The original Parkland sample (n=3,841) was mean age=76.6 years (SD±8.1); mean ISS=12.4 (SD±9.9); mortality=10.8%; and 11.9% received PRBCs at 24 hours. The validation sample (n=18,282) was mean age=77.0 years (SD+8.1); mean ISS=12.3 (SD+10.6); mortality=11.0%; and 14.1% received PRBCs at 24 hours. Fitting the GTOS model to the validation sample revealed that the parameter estimates from the validation sample were similar to those of fitting it to the Parkland sample with highly overlapping 95% confidence limits. The misclassification (error) rate for the GTOS logistic model applied to the validation sample was 9.97%, similar to that of the Parkland sample (9.79%). Brier score, Tjur R-square, and AUC for the GTOS logistic model when applied to the validation sample were 0.07, 0.25, and 0.86, respectively, compared with 0.08, 0.20, and 0.82, respectively, for the Parkland sample. CONCLUSION: Utilizing data available at 24 hours post-injury, the GTOS accurately predicts in-hospital mortality for the injured elderly. LEVEL OF EVIDENCE: III STUDY TYPE: Prognostic

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