Validation of a Geriatric Trauma Prognosis Calculator: A P.A.L.Li.A.T.E. Consortium Study

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

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background/Objectives: The P.A.L.Li.A.T.E. (prognostic assessment of life and limitations after trauma in the elderly) consortium has previously created a prognosis calculator for mortality after geriatric injury based on age, injury severity, and transfusion requirement called the geriatric trauma outcome score (GTOS). Here, we sought to create and validate a prognosis calculator called the geriatric trauma outcome score ii (GTOS II) estimating probability of unfavorable discharge. Design: Retrospective cohort. Setting: Four geographically diverse Level 1 trauma centers. Participants: Trauma admissions aged 65 to 102 years surviving to discharge from 2000 to 2013. Intervention: None. Measurements: Age, injury severity score (ISS), transfusion at 24 hours post-admission, discharge dichotomized as favorable (home/rehabilitation) or unfavorable (skilled nursing/long term acute care/hospice). Training and testing samples were created using the holdout method. A multiple logistic mixed model (GTOS II) was created to estimate the odds of unfavorable disposition then re-specified using the GTOS II as the sole predictor in a logistic mixed model using the testing sample. Results: The final dataset was 16,114 subjects (unfavorable discharge status = 15.4%). Training (n = 8,057) and testing (n = 8,057) samples had similar demographics. The formula based on the training sample was (GTOS II = Age + [0.71 × ISS] + 8.79 [if transfused by 24 hours]). Misclassification rate and AUC were 15.63% and 0.67 for the training sample, respectively, and 15.85% and 0.67 for the testing sample. Conclusion: GTOS II estimates the probability of unfavorable discharge in injured elders with moderate accuracy. With the GTOS mortality calculator, it can help in goal setting conversations after geriatric injury.

Original languageEnglish (US)
Pages (from-to)2302-2307
Number of pages6
JournalJournal of the American Geriatrics Society
Volume65
Issue number10
DOIs
StatePublished - Oct 1 2017

Fingerprint

Geriatrics
Wounds and Injuries
Injury Severity Score
Logistic Models
Hospices
Mortality
Trauma Centers
Long-Term Care
Area Under Curve
Nursing
Rehabilitation
Demography

Keywords

  • elderly
  • geriatric
  • outcomes
  • prognosis calculator
  • scoring system
  • trauma

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Validation of a Geriatric Trauma Prognosis Calculator : A P.A.L.Li.A.T.E. Consortium Study. / Cook, Allyson C.; Joseph, Bellal; Mohler, M. Jane; Inaba, Kenji; Bruns, Brandon R.; Nakonezny, Paul A.; Kerby, Jeff D.; Brasel, Karen J.; Wolf, Steven E.; Cuschieri, Joseph; Paulk, M. Elizabeth; Rhodes, Ramona L.; Brakenridge, Scott C.; Ekeh, A. Peter; Phelan, Herb A.

In: Journal of the American Geriatrics Society, Vol. 65, No. 10, 01.10.2017, p. 2302-2307.

Research output: Contribution to journalArticle

Cook, AC, Joseph, B, Mohler, MJ, Inaba, K, Bruns, BR, Nakonezny, PA, Kerby, JD, Brasel, KJ, Wolf, SE, Cuschieri, J, Paulk, ME, Rhodes, RL, Brakenridge, SC, Ekeh, AP & Phelan, HA 2017, 'Validation of a Geriatric Trauma Prognosis Calculator: A P.A.L.Li.A.T.E. Consortium Study', Journal of the American Geriatrics Society, vol. 65, no. 10, pp. 2302-2307. https://doi.org/10.1111/jgs.15009
Cook, Allyson C. ; Joseph, Bellal ; Mohler, M. Jane ; Inaba, Kenji ; Bruns, Brandon R. ; Nakonezny, Paul A. ; Kerby, Jeff D. ; Brasel, Karen J. ; Wolf, Steven E. ; Cuschieri, Joseph ; Paulk, M. Elizabeth ; Rhodes, Ramona L. ; Brakenridge, Scott C. ; Ekeh, A. Peter ; Phelan, Herb A. / Validation of a Geriatric Trauma Prognosis Calculator : A P.A.L.Li.A.T.E. Consortium Study. In: Journal of the American Geriatrics Society. 2017 ; Vol. 65, No. 10. pp. 2302-2307.
@article{c7bac7007f174ed195773d13e439cbd0,
title = "Validation of a Geriatric Trauma Prognosis Calculator: A P.A.L.Li.A.T.E. Consortium Study",
abstract = "Background/Objectives: The P.A.L.Li.A.T.E. (prognostic assessment of life and limitations after trauma in the elderly) consortium has previously created a prognosis calculator for mortality after geriatric injury based on age, injury severity, and transfusion requirement called the geriatric trauma outcome score (GTOS). Here, we sought to create and validate a prognosis calculator called the geriatric trauma outcome score ii (GTOS II) estimating probability of unfavorable discharge. Design: Retrospective cohort. Setting: Four geographically diverse Level 1 trauma centers. Participants: Trauma admissions aged 65 to 102 years surviving to discharge from 2000 to 2013. Intervention: None. Measurements: Age, injury severity score (ISS), transfusion at 24 hours post-admission, discharge dichotomized as favorable (home/rehabilitation) or unfavorable (skilled nursing/long term acute care/hospice). Training and testing samples were created using the holdout method. A multiple logistic mixed model (GTOS II) was created to estimate the odds of unfavorable disposition then re-specified using the GTOS II as the sole predictor in a logistic mixed model using the testing sample. Results: The final dataset was 16,114 subjects (unfavorable discharge status = 15.4{\%}). Training (n = 8,057) and testing (n = 8,057) samples had similar demographics. The formula based on the training sample was (GTOS II = Age + [0.71 × ISS] + 8.79 [if transfused by 24 hours]). Misclassification rate and AUC were 15.63{\%} and 0.67 for the training sample, respectively, and 15.85{\%} and 0.67 for the testing sample. Conclusion: GTOS II estimates the probability of unfavorable discharge in injured elders with moderate accuracy. With the GTOS mortality calculator, it can help in goal setting conversations after geriatric injury.",
keywords = "elderly, geriatric, outcomes, prognosis calculator, scoring system, trauma",
author = "Cook, {Allyson C.} and Bellal Joseph and Mohler, {M. Jane} and Kenji Inaba and Bruns, {Brandon R.} and Nakonezny, {Paul A.} and Kerby, {Jeff D.} and Brasel, {Karen J.} and Wolf, {Steven E.} and Joseph Cuschieri and Paulk, {M. Elizabeth} and Rhodes, {Ramona L.} and Brakenridge, {Scott C.} and Ekeh, {A. Peter} and Phelan, {Herb A.}",
year = "2017",
month = "10",
day = "1",
doi = "10.1111/jgs.15009",
language = "English (US)",
volume = "65",
pages = "2302--2307",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - Validation of a Geriatric Trauma Prognosis Calculator

T2 - A P.A.L.Li.A.T.E. Consortium Study

AU - Cook, Allyson C.

AU - Joseph, Bellal

AU - Mohler, M. Jane

AU - Inaba, Kenji

AU - Bruns, Brandon R.

AU - Nakonezny, Paul A.

AU - Kerby, Jeff D.

AU - Brasel, Karen J.

AU - Wolf, Steven E.

AU - Cuschieri, Joseph

AU - Paulk, M. Elizabeth

AU - Rhodes, Ramona L.

AU - Brakenridge, Scott C.

AU - Ekeh, A. Peter

AU - Phelan, Herb A.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background/Objectives: The P.A.L.Li.A.T.E. (prognostic assessment of life and limitations after trauma in the elderly) consortium has previously created a prognosis calculator for mortality after geriatric injury based on age, injury severity, and transfusion requirement called the geriatric trauma outcome score (GTOS). Here, we sought to create and validate a prognosis calculator called the geriatric trauma outcome score ii (GTOS II) estimating probability of unfavorable discharge. Design: Retrospective cohort. Setting: Four geographically diverse Level 1 trauma centers. Participants: Trauma admissions aged 65 to 102 years surviving to discharge from 2000 to 2013. Intervention: None. Measurements: Age, injury severity score (ISS), transfusion at 24 hours post-admission, discharge dichotomized as favorable (home/rehabilitation) or unfavorable (skilled nursing/long term acute care/hospice). Training and testing samples were created using the holdout method. A multiple logistic mixed model (GTOS II) was created to estimate the odds of unfavorable disposition then re-specified using the GTOS II as the sole predictor in a logistic mixed model using the testing sample. Results: The final dataset was 16,114 subjects (unfavorable discharge status = 15.4%). Training (n = 8,057) and testing (n = 8,057) samples had similar demographics. The formula based on the training sample was (GTOS II = Age + [0.71 × ISS] + 8.79 [if transfused by 24 hours]). Misclassification rate and AUC were 15.63% and 0.67 for the training sample, respectively, and 15.85% and 0.67 for the testing sample. Conclusion: GTOS II estimates the probability of unfavorable discharge in injured elders with moderate accuracy. With the GTOS mortality calculator, it can help in goal setting conversations after geriatric injury.

AB - Background/Objectives: The P.A.L.Li.A.T.E. (prognostic assessment of life and limitations after trauma in the elderly) consortium has previously created a prognosis calculator for mortality after geriatric injury based on age, injury severity, and transfusion requirement called the geriatric trauma outcome score (GTOS). Here, we sought to create and validate a prognosis calculator called the geriatric trauma outcome score ii (GTOS II) estimating probability of unfavorable discharge. Design: Retrospective cohort. Setting: Four geographically diverse Level 1 trauma centers. Participants: Trauma admissions aged 65 to 102 years surviving to discharge from 2000 to 2013. Intervention: None. Measurements: Age, injury severity score (ISS), transfusion at 24 hours post-admission, discharge dichotomized as favorable (home/rehabilitation) or unfavorable (skilled nursing/long term acute care/hospice). Training and testing samples were created using the holdout method. A multiple logistic mixed model (GTOS II) was created to estimate the odds of unfavorable disposition then re-specified using the GTOS II as the sole predictor in a logistic mixed model using the testing sample. Results: The final dataset was 16,114 subjects (unfavorable discharge status = 15.4%). Training (n = 8,057) and testing (n = 8,057) samples had similar demographics. The formula based on the training sample was (GTOS II = Age + [0.71 × ISS] + 8.79 [if transfused by 24 hours]). Misclassification rate and AUC were 15.63% and 0.67 for the training sample, respectively, and 15.85% and 0.67 for the testing sample. Conclusion: GTOS II estimates the probability of unfavorable discharge in injured elders with moderate accuracy. With the GTOS mortality calculator, it can help in goal setting conversations after geriatric injury.

KW - elderly

KW - geriatric

KW - outcomes

KW - prognosis calculator

KW - scoring system

KW - trauma

UR - http://www.scopus.com/inward/record.url?scp=85031501497&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85031501497&partnerID=8YFLogxK

U2 - 10.1111/jgs.15009

DO - 10.1111/jgs.15009

M3 - Article

C2 - 28804877

AN - SCOPUS:85031501497

VL - 65

SP - 2302

EP - 2307

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 10

ER -