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
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
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DOI：
10.1097/ta.0000000000000926
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发表时间：
2016-02-01
影响因子：
3.4
通讯作者：
Phelan, Herb A.
中科院分区：
文献类型：
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作者：
Cook, Allyson C.;Joseph, Bellal;Phelan, Herb A.
背景：老年创伤预后评分(GTOS)是根据Parkland医院13年来的老年创伤患者的数据开发的，GTOS=[年龄]+[ISS x 2.5]+[22，如果入院后24小时内输注任何PRBC]。我们试图验证这一模型。方法：在原始研究期间，四个I级中心确定了65岁或以上的受试者。GTOS模型首先使用从Parkland样本发展而来的公式[GTOS=年龄+(ISS x 2.5)+22(如果给定24小时的PRBC)]，然后用作Logistic混合模型中的唯一预测因子，估计验证样本中的死亡概率，并将地点视为随机效应。结果：原始Parkland样本(n=3,841)的平均年龄(SD)为76.6(8.1)岁，平均ISS(SD)为12.4(9.9)岁，死亡率为10.8%，24小时接受PRBC治疗的患者死亡率为11.9%。验证样本(n=18,282)的平均(SD)年龄为77.0(8.1)岁，平均(SD)ISS为12.3(10.6)，死亡率为11.0%，14.1%的患者在24小时内接受PRBC治疗。GTOS模型对验证样本的拟合表明，验证样本的参数估计值与Parkland样本的参数估计值相似，具有高度重叠的95%置信限。应用于验证样本的GTOS Logistic模型的错误分类(错误率)为9.97%，与Parkland样本(9.79%)相似。应用于验证样本的GTOS Logistic模型的Brier评分、Tjur R-2和曲线下面积分别为0.07、0.25和0.86，而Parkland样本的分别为0.08、0.20和0.82。结论：GTOS利用受伤后24小时的数据，准确地预测了受伤老年人的住院死亡率。(版权所有(C)2016 Wolters KluwerHealth，Inc.保留所有权利。)
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 this model.METHODS: Four Level I centers identified subjects who are 65 years or older 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 and 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-2, and the area under the curve in evaluating the predictive performance of the GTOS model.RESULTS: The original Parkland sample (n = 3,841) had a mean (SD) age of 76.6 (8.1) years, mean (SD) ISS of 12.4 (9.9), mortality of 10.8%, and 11.9% receiving PRBCs at 24 hours. The validation sample (n = 18,282) had a mean (SD) age of 77.0 (8.1) years, mean (SD) ISS of 12.3 (10.6), mortality of 11.0%, and 14.1% receiving 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-2, and the area under the curve 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: With the use of the data available at 24 hours after injury, the GTOS accurately predicts in-hospital mortality for the injured elderly. (Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.)