S. L. Nitzschke1, G. Barmparas2, O. Olugajo3, C. Burns1, Z. Cooper1, A. Haider1, A. Salim1 2Cedars-Sinai Medical Center,Los Angeles, CA, USA 3Washington University,St. Louis, MO, USA 1Brigham And Women’s Hospital,Trauma/Surgery/Harvard,Boston, MA, USA
Introduction: Although physiologic data has been used to help appropriately triage severely injured trauma patients of all ages, the ability of these parameters to predict injury severity among geriatric patients has not been examined. The purpose of this study is to determine if physiologic and clinical data available at the time of triage in the emergency department (ED) would be predictive of injury severity in elderly trauma patients.
Methods: A retrospective review of the National Trauma Data Bank (2007-2011) was queried for patients aged 65-90 with blunt trauma. Data collection included basic demographic data, as well as initial heart rate, systolic blood pressure, and Glasgow Coma Scale (GCS). The shock index (SI) was also calculated. Our primary outcome of interest was moderate-to-severe injury defined as injury severity score (ISS) ≥ 9 or head Abbreviated Injury Score (AIS) ≥3. The other outcome of interest was in-hospital mortality. Various univariate and multi-variable logistic regression models using different combinations of physiologic data were built and performances of the models were measured with the area under receiver operating characteristic (AUROC) curve.
Results: A total of 394,727 patients met our inclusion criteria (61% had ISS ≥ 9, 21% had a head AIS ≥3, and overall mortality was 5.2%). None of our models were predictive of ISS ≥ 9 (all AUROC ≤0.5), and ED GCS was moderately predictive of head AIS ≥ 3 (AUROC of 0.639). The ED GCS was the best predictor of in-hospital mortality (AUROC of 0.717).
Conclusion: Our data show that initial physiologic and clinical data appear to have little predictive value on injury severity in an elderly patient population, but ED GCS appears adequate in predicting mortality. In order to facilitate appropriate triage of the severely injured trauma patient in this growing population, this study suggests that a new set of triage criteria may be required for the geriatric patient.