• 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, and Herb A Phelan.
• UT Southwestern Department of Surgery, Division of Burns/Trauma/Critical Care, Parkland Memorial Hospital, Dallas, Texas.
• J Am Geriatr Soc. 2017 Oct 1; 65 (10): 2302-2307.

Background/ObjectivesThe 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.DesignRetrospective cohort.SettingFour geographically diverse Level 1 trauma centers.ParticipantsTrauma admissions aged 65 to 102 years surviving to discharge from 2000 to 2013.InterventionNone.MeasurementsAge, 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.ResultsThe 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.ConclusionGTOS 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.© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

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