Top

World Journal of Emergency Surgery

Published in:

Open Access 01-12-2020 | Research article

The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients

Authors: Libing Jiang, Zhongjun Zheng, Mao Zhang

Published in: World Journal of Emergency Surgery | Issue 1/2020

Abstract

Purpose

The study aimed to examine the changing incidence of geriatric trauma and evaluate the predictive ability of different scoring tools for in-hospital mortality in geriatric trauma patients.

Methods

Annual reports released by the National Trauma Database (NTDB) in the USA from 2005 to 2015 and the Trauma Register DGU® in Germany from 1994 to 2012 were analyzed to examine the changing incidence of geriatric trauma. Secondary analysis of a single-center cohort study conducted among 311 severely injured geriatric trauma patients in a level I trauma center in Switzerland was completed. According to the in-hospital survival status, patients were divided into the survival and non-survival group. The differences of the ISS (injury severity score), NISS (new injury severity score), TRISS (Trauma and Injury Severity Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SPAS II (simplified acute physiology score II) between two groups were evaluated. Then, the areas under the receiver-operating characteristic curve (AUC-ROC) of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients were calculated.

Results

The analysis of the NTDB showed that the increase in the number of geriatric trauma ranged from 18 to 30% between 2005 and 2015. The analysis of the DGU® showed that the mean age of trauma patients rose from 39.11 in 1993 to 51.10 in 2013, and the proportion of patients aged ≥ 60 years rose from 16.5 to 37.5%. The findings from the secondary analysis showed that 164 (52.73%) patients died in the hospital. The ISS, NISS, APACHE II, and SAPS II in the death group were significantly higher than those in the survival group, and the TRISS in the death group was significantly lower than those in the survival group. The AUCs of the ISS, NISS, TRISS, APACHE II, and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients were 0.807, 0.850, 0.828, 0.715, and 0.725, respectively.

Conclusion

The total number of geriatric trauma is increasing as the population ages. The accuracy of ISS, NISS and TRISS was higher than the APACHE II and SAPS II for the prediction of in-hospital mortality in geriatric trauma patients.

Available only for authorised users

Jiang L, Ma Y, Jiang S, Ye L, Zheng Z, Xu Y, Zhang M. Comparison of whole-body computed tomography vs selective radiological imaging on outcomes in major trauma patients: a meta-analysis. Scand J Trauma Resusc Emerg Med. 2014;22:54.CrossRef

Moore L, Champion H, Tardif PA, Kuimi BL, O'Reilly G, Leppaniemi A, Cameron P, Palmer CS, Abu-Zidan FM, Gabbe B, et al. Impact of trauma system structure on injury outcomes: a systematic review and meta-analysis. World J Surg. 2018;42(5):1327–39.CrossRef

Adams SD, Holcomb JB. Geriatric trauma. Curr Opin Crit Care. 2015;21(6):520–6.

Benoit E, Stephen AH, Monaghan SF, Lueckel SN, Adams CA Jr. Geriatric Trauma. Rhode Island Med J. 2019;102(8):19–22.

Horst MA, Morgan ME, Vernon TM, Bradburn EH, Cook AD, Shtayyeh T, D'Andrea L, Rogers FB. The geriatric trauma patient: a neglected individual in a mature trauma system. J Trauma Acute Care Surg. 2020;89(1):192–8.CrossRef

Southern AP, Lopez RA, Jwayyed S. Geriatric Trauma. In: StatPearls. Treasure Island: StatPearls Publishing; 2020.

Callaway DW, Wolfe R. Geriatric trauma. Emergency medicine clinics of North America. 2007;25(3):837–60 x.CrossRef

Pohlemann T, Histing T. Challenges in geriatric trauma care. Innovative surgical sciences. 2016;1(2):47–8.CrossRef

Friess T, Hartwig E, Liener U, Sturm J, Hoffmann R. Geriatric trauma centers from the idea to implementation. What has been achieved? Der Unfallchirurg. 2016;119(1):7–11.CrossRef

10.

Gogol M, van den Heuvel D, Luttje D, Pullen R, Reingraber AC, Schulz RJ, Veer A, Wittrich A. Geriatric trauma centers - requirements catalog. An initiative to promote and guarantee the quality of care of elderly trauma patients receiving inpatient care. Z Gerontol Geriatr. 2014;47(4):310–6.CrossRef

11.

Pape HC, Friess T, Liener U, Ruchholtz S, Schmucker U, Sturm JA, Buecking G, Riem S, Hartwig E. Development of geriatric trauma centers—an effort by the German Society for Trauma and Orthopaedics. Injury. 2014;45(10):1513–5.CrossRef

12.

Barea-Mendoza JA, Chico-Fernandez M, Sanchez-Casado M, Molina-Diaz I, Quintana-Diaz M, Jimenez-Moragas JM, Perez-Barcena J, Llompart-Pou JA, en representacion del Grupo de Trabajo de Neurointensivismo y Trauma de la Sociedad Espanola de Medicina Intensiva CyUC. Predicting survival in geriatric trauma patients: a comparison between the TRISS methodology and the Geriatric Trauma Outcome Score. Cirugia Espanola. 2018;96(6):357–62.CrossRef

13.

Madni TD, Ekeh AP, Brakenridge SC, Brasel KJ, Joseph B, Inaba K, Bruns BR, Kerby JD, Cuschieri J, Mohler MJ, et al. A comparison of prognosis calculators for geriatric trauma: a prognostic assessment of life and limitations after trauma in the elderly consortium study. J Trauma Acute Care Surg. 2017;83(1):90–6.CrossRef

14.

Cook AC, Joseph B, Mohler MJ, Inaba K, Bruns BR, Nakonezny PA, Kerby JD, Brasel KJ, Wolf SE, Cuschieri J, et al. Validation of a geriatric trauma prognosis calculator: a P.A.L.Li.A.T.E. consortium study. J Am Geriatr Soc. 2017;65(10):2302–7.CrossRef

15.

Mehmood A, Hung YW, He H, Ali S, Bachani AM. Performance of injury severity measures in trauma research: a literature review and validation analysis of studies from low-income and middle-income countries. BMJ Open. 2019;9(1):e023161.CrossRef

16.

Peterer L, Ossendorf C, Jensen KO, Osterhoff G, Mica L, Seifert B, Werner CML, Simmen HP, Pape HC, Sprengel K. Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study. BMC Geriatr. 2019;19(1):359.CrossRef

17.

18.

Watts G. Jiang Baoguo: one, two, three against trauma in China. Lancet. 2017;390(10104):1729.CrossRef

19.

Ludi E, Boeck M, South S, Monasterio J, Swaroop M, Foianini E. Geriatric trauma in Santa Cruz, Bolivia. The Journal of surgical research. 2019;244:212–7.CrossRef

20.

Gioffre-Florio M, Murabito LM, Visalli C, Pergolizzi FP, Fama F. Trauma in elderly patients: a study of prevalence, comorbidities and gender differences. Il Giornale di chirurgia. 2018;39(1):35–40.CrossRef

21.

Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. EMJ. 2015;32(12):911–5.CrossRef

22.

Cutugno CL. The 'graying' of trauma care: addressing traumatic injury in older adults. Am J Nurs. 2011;111(11):40–8 quiz 49-50.CrossRef

23.

Bortz KL. Creating a geriatric-focused model of care in trauma with geriatric education. J Trauma Nurs. 2015;22(6):301–5 quiz E301-302.CrossRef

24.

Moran CG, Lecky F, Bouamra O, Lawrence T, Edwards A, Woodford M, Willett K, Coats TJ. Changing the system - major trauma patients and their outcomes in the NHS (England) 2008-17. EClinicalMedicine. 2018;2-3:13–21.CrossRef

25.

Doyle R, Brent L, Connolly A, Breslin T, Jones S, Kelly F, Lawrence T, Deasy C. Major trauma in the older person - major challenges ahead. Age Ageing. 2019;48(Supplement_3):iii1-iii16.

26.

Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRef

27.

Frankema SP, Steyerberg EW, Edwards MJ, van Vugt AB. Comparison of current injury scales for survival chance estimation: an evaluation comparing the predictive performance of the ISS, NISS, and AP scores in a Dutch local trauma registration. J Trauma. 2005;58(3):596–604.CrossRef

28.

Lavoie A, Moore L, LeSage N, Liberman M, Sampalis JS. The new injury severity score: a more accurate predictor of in-hospital mortality than the injury severity score. J Trauma. 2004;56(6):1312–20.CrossRef

29.

Nogueira Lde S, Domingues Cde A, Campos Mde A, Sousa RM. Ten years of new injury severity score (NISS): is it a possible change? Revista Latino-Americana de Enfermagem. 2008;16(2):314–9.CrossRef

30.

Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27(4):370–8.CrossRef

31.

Javali RH, Krishnamoorthy PA, Srinivasarangan M, Suraj S. Comparison of Injury Severity Score, New Injury Severity Score, Revised Trauma Score and Trauma and Injury Severity Score for Mortality Prediction in Elderly Trauma Patients. Ind J Crit Care Med. 2019;23(2):73–7.CrossRef

32.

Yousefzadeh-Chabok S, Hosseinpour M, Kouchakinejad-Eramsadati L, Ranjbar F, Malekpouri R, Razzaghi A, Mohtasham-Amiri Z. Comparison of revised trauma score, injury severity score and trauma and injury severity score for mortality prediction in elderly trauma patients. Ulusal travma ve acil cerrahi dergisi. 2016;22(6):536–40.PubMed

33.

Thanapaisal C, Saksaen P. A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Trauma-Injury Severity Score (TRISS) for outcome assessment in Srinagarind Intensive Care Unit trauma patients. J Med Assoc Thailand. 2012;95(Suppl 11):S25–33.

34.

Hwang SY, Lee JH, Lee YH, Hong CK, Sung AJ, Choi YC. Comparison of the sequential organ failure assessment, acute physiology and chronic health evaluation ii scoring system, and trauma and injury severity score method for predicting the outcomes of intensive care unit trauma patients. Am J Emerg Med. 2012;30(5):749–53.CrossRef

35.

Vassar MJ, Lewis FR Jr, Chambers JA, Mullins RJ, O'Brien PE, Weigelt JA, Hoang MT, Holcroft JW. Prediction of outcome in intensive care unit trauma patients: a multicenter study of Acute Physiology and Chronic Health Evaluation (APACHE), Trauma and Injury Severity Score (TRISS), and a 24-hour intensive care unit (ICU) point system. J Trauma. 1999;47(2):324–9.CrossRef

36.

Wong DT, Barrow PM, Gomez M, McGuire GP. A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Trauma-Injury Severity Score (TRISS) for outcome assessment in intensive care unit trauma patients. Crit Care Med. 1996;24(10):1642–8.CrossRef

37.

Reiter A, Mauritz W, Jordan B, Lang T, Pölzl A, Pelinka L, Metnitz PG. Improving risk adjustment in critically ill trauma patients: the TRISS-SAPS Score. J Trauma. 2004;57(2):375–80.CrossRef

38.

Fueglistaler P, Amsler F, Schüepp M, Fueglistaler-Montali I, Attenberger C, Pargger H, Jacob AL, Gross T. Prognostic value of Sequential Organ Failure Assessment and Simplified Acute Physiology II Score compared with trauma scores in the outcome of multiple-trauma patients. Am J Surg. 2010;200(2):204–14.CrossRef

39.

Zhao FZ, Wolf SE, Nakonezny PA, Minhajuddin A, Rhodes RL, Paulk ME, Phelan HA. Estimating Geriatric Mortality after Injury Using Age, Injury Severity, and Performance of a Transfusion: The Geriatric Trauma Outcome Score. J Palliat Med. 2015;18(8):677–81.CrossRef

40.

Cook AC, Joseph B, Inaba K, Nakonezny PA, Bruns BR, Kerby JD, Brasel KJ, Wolf SE, Cuschieri J, Paulk ME, et al. 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. J Trauma Acute Care Surg. 2016;80(2):204–9.CrossRef

Title: The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients
Authors: Libing Jiang
Zhongjun Zheng
Mao Zhang
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: World Journal of Emergency Surgery / Issue 1/2020
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-020-00340-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

WSES guidelines updates

Trauma system developments reduce mortality in hospitalized trauma patients in Al-Ain City, United Arab Emirates, despite increased severity of injury

Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: the WSES classification for pelvic trauma makes sense

Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study

Correction to: The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon’s point of view

Impact of fibrinogen level on the prognosis of patients with traumatic brain injury: a single-center analysis of 2570 patients