Geriatric Trauma Outcome Score as a Mortality Predictor in Isolated Moderate to Severe Traumatic Brain Injury: A Single-Center Retrospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Enrollment and Study Design
2.2. Statistical Analysis
3. Results
3.1. Enrollment of the Patients
3.2. Demographic and Clinical Characteristics of Patients Stratified by in-Hospital Mortality Status
3.3. Univariate and Multivariate Analysis of Factors Associated with In-Hospital Mortality in Isolated Moderate to Severe TBI Patients
3.4. The Optimal Cut-Off Value of GTOS in Predicting In-Hospital Mortality
3.5. Comparative Demographics Outcomes Based on Grouping by GTOS
3.6. Propensity-Score-Matched Analysis of High and Low GTOS Score Groups
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Harrison-Felix, C.L.; Whiteneck, G.G.; Jha, A.; De Vivo, M.J.; Hammond, F.M.; Hart, D.M. Mortality over four decades after traumatic brain injury rehabilitation: A retrospective cohort study. Arch. Phys. Med. Rehabil. 2009, 90, 1506–1513. [Google Scholar] [CrossRef]
- Greenwald, B.D.; Hammond, F.M.; Harrison-Felix, C.; Nakase-Richardson, R.; Howe, L.L.; Kreider, S. Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study. J. Neurotrauma 2015, 32, 1883–1892. [Google Scholar] [CrossRef]
- Utomo, W.K.; Gabbe, B.J.; Simpson, P.M.; Cameron, P.A. Predictors of in-hospital mortality and 6-month functional outcomes in older adults after moderate to severe traumatic brain injury. Injury 2009, 40, 973–977. [Google Scholar] [CrossRef] [PubMed]
- Ahl, R.; Phelan, H.A.; Dogan, S.; Cao, Y.; Cook, A.C.; Mohseni, S. Predicting In-Hospital and 1-Year Mortality in Geriatric Trauma Patients Using Geriatric Trauma Outcome Score. J. Am. Coll. Surg. 2017, 224, 264–269. [Google Scholar] [CrossRef]
- Ravindranath, S.; Ho, K.M.; Rao, S.; Nasim, S.; Burrell, M. Validation of the geriatric trauma outcome scores in predicting outcomes of elderly trauma patients. Injury 2021, 52, 154–159. [Google Scholar] [CrossRef] [PubMed]
- Scherer, J.; Kalbas, Y.; Ziegenhain, F.; Neuhaus, V.; Lefering, R.; Teuben, M.; Sprengel, K.; Pape, H.C.; Jensen, K.O. The GERtality Score: The Development of a Simple Tool to Help Predict in-Hospital Mortality in Geriatric Trauma Patients. J. Clin. Med. 2021, 10, 1362. [Google Scholar] [CrossRef]
- Zhao, F.Z.; Wolf, S.E.; Nakonezny, P.A.; Minhajuddin, A.; Rhodes, R.L.; Paulk, M.E.; Phelan, H.A. Estimating Geriatric Mortality after Injury Using Age, Injury Severity, and Performance of a Transfusion: The Geriatric Trauma Outcome Score. J. Palliat. Med. 2015, 18, 677–681. [Google Scholar] [CrossRef] [PubMed]
- Zhuang, Y.; Feng, Q.; Tang, H.; Wang, Y.; Li, Z.; Bai, X. Predictive Value of the Geriatric Trauma Outcome Score in Older Patients After Trauma: A Retrospective Cohort Study. Int. J. Gen. Med. 2022, 15, 4379–4390. [Google Scholar] [CrossRef]
- Cook, A.C.; Joseph, B.; Inaba, K.; Nakonezny, P.A.; Bruns, B.R.; Kerby, J.D.; Brasel, K.J.; Wolf, S.E.; Cuschieri, J.; Paulk, M.E.; 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, 204–209. [Google Scholar] [CrossRef]
- Arslan Erduhan, M.; Doğan, H.; Ilhan, B. Relationships of the frailty index and geriatric trauma outcome score with mortality in geriatric trauma patients. Ulus. Travma Acil Cerrahi Derg. 2023, 29, 486–492. [Google Scholar] [CrossRef]
- Meagher, A.D.; Lin, A.; Mandell, S.P.; Bulger, E.; Newgard, C. A Comparison of Scoring Systems for Predicting Short- and Long-term Survival After Trauma in Older Adults. Acad. Emerg. Med. 2019, 26, 621–630. [Google Scholar] [CrossRef] [PubMed]
- Madni, T.D.; Ekeh, A.P.; Brakenridge, S.C.; Brasel, K.J.; Joseph, B.; Inaba, K.; Bruns, B.R.; Kerby, J.D.; Cuschieri, J.; Mohler, M.J.; 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, 90–96. [Google Scholar] [CrossRef]
- Park, J.; Lee, Y. Predicting Mortality of Korean Geriatric Trauma Patients: A Comparison between Geriatric Trauma Outcome Score and Trauma and Injury Severity Score. Yonsei Med. J. 2022, 63, 88–94. [Google Scholar] [CrossRef]
- Moorthy, D.; Rajesh, K.; Priya, S.M.; Abhinov, T.; Devendra Prasad, K.J. Prediction of Outcome Based on Trauma and Injury Severity Score, IMPACT and CRASH Prognostic Models in Moderate-to-Severe Traumatic Brain Injury in the Elderly. Asian J. Neurosurg. 2021, 16, 500–506. [Google Scholar] [CrossRef] [PubMed]
- Knaus, W.A.; Draper, E.A.; Wagner, D.P.; Zimmerman, J.E. APACHE II: A severity of disease classification system. Crit. Care Med. 1985, 13, 818–829. [Google Scholar] [CrossRef] [PubMed]
- Le Gall, J.R.; Lemeshow, S.; Saulnier, F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993, 270, 2957–2963. [Google Scholar] [CrossRef]
- Lemeshow, S.; Teres, D.; Klar, J.; Avrunin, J.S.; Gehlbach, S.H.; Rapoport, J. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 1993, 270, 2478–2486. [Google Scholar] [CrossRef]
- Vincent, J.L.; Moreno, R.; Takala, J.; Willatts, S.; De Mendonça, A.; Bruining, H.; Reinhart, C.K.; Suter, P.M.; Thijs, L.G. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure: On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996, 22, 707–710. [Google Scholar] [CrossRef]
- Tsai, C.H.; Liu, H.T.; Hsieh, T.M.; Huang, C.Y.; Chou, S.E.; Su, W.T.; Li, C.; Hsu, S.Y.; Hsieh, C.H. Change of neutrophil-to-monocyte ratio to stratify the mortality risk of adult patients with trauma in the intensive care units. Formos. J. Surg. 2022, 55, 177–183. [Google Scholar] [CrossRef]
- Fluss, R.; Faraggi, D.; Reiser, B. Estimation of the Youden Index and its associated cutoff point. Biom. J. 2005, 47, 458–472. [Google Scholar] [CrossRef]
- Perkins, N.J.; Schisterman, E.F. The Youden Index and the optimal cut-point corrected for measurement error. Biom. J. 2005, 47, 428–441. [Google Scholar] [CrossRef]
- Salim, A.; Hadjizacharia, P.; Du Bose, J.; Brown, C.; Inaba, K.; Chan, L.; Margulies, D.R. Role of anemia in traumatic brain injury. J. Am. Coll. Surg. 2008, 207, 398–406. [Google Scholar] [CrossRef] [PubMed]
- Warner, M.A.; O’Keeffe, T.; Bhavsar, P.; Shringer, R.; Moore, C.; Harper, C.; Madden, C.J.; Sarode, R.; Gentilello, L.M.; Diaz-Arrastia, R. Transfusions and long-term functional outcomes in traumatic brain injury. J. Neurosurg. 2010, 113, 539–546. [Google Scholar] [CrossRef]
- Acker, S.N.; Partrick, D.A.; Ross, J.T.; Nadlonek, N.A.; Bronsert, M.; Bensard, D.D. Blood component transfusion increases the risk of death in children with traumatic brain injury. J. Trauma Acute Care Surg. 2014, 76, 1082–1087, discussion 1087–1088. [Google Scholar] [CrossRef]
- Litofsky, N.S.; Martin, S.; Diaz, J.; Ge, B.; Petroski, G.; Miller, D.C.; Barnes, S.L. The Negative Impact of Anemia in Outcome from Traumatic Brain Injury. World Neurosurg. 2016, 90, 82–90. [Google Scholar] [CrossRef]
- Benson, C. Diffuse Axonal Injury. In Encyclopedia of the Neurological Sciences, 2nd ed.; Aminoff, M.J., Daroff, R.B., Eds.; Academic Press: Oxford, UK, 2014; pp. 998–999. [Google Scholar] [CrossRef]
- Huh, J.W.; Raghupathi, R. Chronic Cognitive Deficits and Long-Term Histopathological Alterations following Contusive Brain Injury in the Immature Rat. J. Neurotrauma 2007, 24, 1460–1474. [Google Scholar] [CrossRef]
- Smith, M. Diffuse axonal injury in adults. Trauma 2003, 5, 227–234. [Google Scholar] [CrossRef]
- Mingℯ, H.K.; Ravindranath, S. Geriatric Trauma Outcome Score (GTOS) in elderly patients with traumatic brain injury. Injury 2022, 53, 4169. [Google Scholar] [CrossRef] [PubMed]
- Barea-Mendoza, J.A.; Chico-Fernández, M.; Sánchez-Casado, M.; Llompart-Pou, J.A. Performance of the Geriatric Trauma Outcome Score in traumatic brain injury: A call of caution. Injury 2022, 53, 2683–2684. [Google Scholar] [CrossRef] [PubMed]
- Christie, S.A.; Conroy, A.S.; Callcut, R.A.; Hubbard, A.E.; Cohen, M.J. Dynamic multi-outcome prediction after injury: Applying adaptive machine learning for precision medicine in trauma. PLoS ONE 2019, 14, e0213836. [Google Scholar] [CrossRef]
- Rau, C.-S.; Kuo, P.-J.; Chien, P.-C.; Huang, C.-Y.; Hsieh, H.-Y.; Hsieh, C.-H. Mortality prediction in patients with isolated moderate and severe traumatic brain injury using machine learning models. PLoS ONE 2018, 13, e0207192. [Google Scholar] [CrossRef] [PubMed]
Variables | Death n = 462 | Survival n = 5081 | OR (95% CI) | p |
---|---|---|---|---|
Sex | 0.006 | |||
Male, n (%) | 312 (67.5) | 3104 (61.1) | 1.33 (1.08–1.62) | |
Female, n (%) | 150 (32.5) | 1977 (38.9) | 0.76 (0.62–0.92) | |
Age, years (mean ± SD) | 64.1 ± 18.2 | 58.0 ± 19.1 | - | <0.001 |
PRBC, units | 2.4 ± 4.4 | 0.4 ± 1.5 | - | <0.001 |
GTOS | 131.2 ± 25.5 | 100.5 ± 24.4 | - | <0.001 |
Comorbidities | ||||
CVA, n (%) | 32 (6.9) | 315 (6.2) | 1.13 (0.77–1.64) | 0.537 |
HTN, n (%) | 198 (42.9) | 1852 (36.4) | 1.31 (1.08–1.59) | 0.006 |
CAD, n (%) | 58 (12.6) | 320 (6.3) | 2.14 (1.59–2.88) | <0.001 |
CHF, n (%) | 4 (0.9) | 39 (0.8) | 1.13 (0.40–3.17) | 0.818 |
DM, n (%) | 93 (20.1) | 1005 (19.8) | 1.02 (0.81–1.30) | 0.856 |
ESRD, n (%) | 47 (10.2) | 126 (2.5) | 4.45 (3.14–6.32) | <0.001 |
GCS, median (IQR) | 5 (3–11) | 15 (13–15) | - | <0.001 |
3–8, n (%) | 319 (69.0) | 654 (12.9) | 15.10 (12.20–18.70) | <0.001 |
9–12, n (%) | 40 (8.7) | 543 (10.7) | 0.79 (0.57–1.11) | 0.174 |
13–15, n (%) | 103 (22.3) | 3884 (76.4) | 0.09 (0.07–0.11) | <0.001 |
ISS, median (IQR) | 25 (16–25) | 16 (13–20) | - | <0.001 |
1–15, n (%) | 25 (5.4) | 1669 (32.8) | 0.12 (0.08–0.18) | <0.001 |
16–24, n (%) | 128 (27.7) | 2983 (58.7) | 0.27 (0.22–0.33) | <0.001 |
≥25, n (%) | 309 (66.9) | 429 (8.4) | 21.90 (17.62–27.22) | <0.001 |
Hospital stay (days) | 9.3 ± 14.4 | 12.4 ± 12.9 | - | <0.001 |
Variables | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
OR | CI | p | OR | CI | p | |
Male | 1.33 | (1.08–1.62) | 0.007 | 1.46 | (1.15–1.84) | 0.002 |
Age | 1.19 | (1.13–1.26) | <0.001 | 0.98 | (0.86–1.11) | 0.734 |
GTOS | 1.67 | (1.59–1.75) | <0.001 | 1.33 | (1.19–1.49) | <0.001 |
HTN | 1.31 | (1.08–1.59) | 0.006 | 1.03 | (0.80–1.31) | 0.845 |
CAD | 2.14 | (1.59–2.88) | <0.001 | 1.42 | (0.99–2.04) | 0.054 |
ESRD | 4.45 | (3.14–6.32) | <0.001 | 4.72 | (3.10–7.18) | <0.001 |
ISS | 1.26 | (1.24–1.29) | <0.001 | 1.17 | (1.12–1.22) | <0.001 |
Model | Standardized Coefficients | t | p | Collinearity Statistics | |
---|---|---|---|---|---|
Beta | Tolerance | VIF | |||
(Constant) | 35.634 | 0.000 | |||
Male | 0.031 | 2.447 | 0.014 | 0.974 | 1.027 |
Age | 0.201 | 5.644 | 0.000 | 0.119 | 8.413 |
ISS | −0.098 | −3.094 | 0.002 | 0.150 | 6.659 |
GTOS | −0.396 | −8.793 | 0.000 | 0.075 | 13.396 |
HTN | −0.004 | −318 | 0.750 | 0.759 | 1.317 |
CAD | 0.030 | 2.343 | 0.019 | 0.927 | 1.079 |
ESRD | 0.101 | 8.090 | 0.000 | 0.970 | 1.031 |
GTOS | ||||
---|---|---|---|---|
≥121.5 n = 1252 | <121.5 n = 4291 | OR (95% CI) | p | |
Sex | 0.527 | |||
Male, n (%) | 762 (60.9) | 2654 (61.9) | 0.96 (0.84–1.09) | |
Female, n (%) | 490 (39.1) | 1637 (38.1) | 1.04 (0.92–1.19) | |
Age, years (mean ± SD) | 73.6 ± 13.6 | 54.1 ± 18.2 | - | <0.001 |
PRBC, units | 1.8 ± 3.2 | 0.2 ± 1.2 | - | <0.001 |
Comorbidities | ||||
CVA, n (%) | 120 (9.6) | 227 (5.3) | 1.90 (1.51–2.39) | <0.001 |
HTN, n (%) | 658 (52.6) | 1392 (32.4) | 2.31 (2.03–2.62) | <0.001 |
CAD, n (%) | 169 (13.5) | 209 (4.9) | 3.05 (2.46–3.77) | <0.001 |
CHF, n (%) | 16 (1.3) | 27 (0.6) | 2.04 (1.10–3.81) | 0.021 |
DM, n (%) | 310 (24.8) | 788 (18.4) | 1.46 (1.26–1.70) | <0.001 |
ESRD, n (%) | 59 (4.7) | 114 (2.7) | 1.81 (1.32–2.50) | <0.001 |
GCS, median (IQR) | 13 (6–15) | 15 (13–15) | - | <0.001 |
3–8, n (%) | 433 (34.6) | 540 (12.6) | 3.67 (3.17–4.26) | <0.001 |
9–12, n (%) | 155 (12.4) | 428 (10.0) | 1.28 (1.05–1.55) | 0.015 |
13–15, n (%) | 664 (53.0) | 3323 (77.4) | 0.33 (0.29–0.38) | <0.001 |
ISS, median (IQR) | 24 (16–25) | 16 (10–17) | - | <0.001 |
1–15, n (%) | 27 (2.2) | 1667 (38.8) | 0.04 (0.02–0.05) | <0.001 |
16–24, n (%) | 661 (52.8) | 2450 (57.1) | 0.84 (0.74–0.95) | 0.007 |
≥25, n (%) | 564 (45.0) | 174 (4.1) | 19.40 (16.07–23.41) | <0.001 |
Mortality, n (%) | 315 (25.2) | 147 (3.4) | 9.48 (7.70–11.67) | <0.001 |
Hospital stay (days) | 15.7 ± 16.5 | 11.0 ± 11.7 | - | <0.001 |
Propensity Score Matched-Cohort | ||||||||
---|---|---|---|---|---|---|---|---|
GTOS | ||||||||
≥121.5 n = 794 | <121.5 n = 794 | OR (95% CI) | p | SD | ||||
Sex | ||||||||
Male, n (%) | 492 | (62.0) | 492 | (62.0) | 1.00 | (0.82–1.23) | 1.000 | 0.00% |
Age, years ± SD | 69.9 | ±14.1 | 69.2 | ±13.6 | - | 0.292 | 5.29% | |
Co-Morbidity | ||||||||
CVA, n (%) | 61 | (7.7) | 61 | (7.7) | 1.00 | (0.69–1.45) | 1.000 | 0.00% |
HTN, n (%) | 389 | (49.0) | 389 | (49.0) | 1.00 | (0.82–1.22) | 1.000 | 0.00% |
CAD, n (%) | 78 | (9.8) | 78 | (9.8) | 1.00 | (0.72–1.39) | 1.000 | 0.00% |
CHF, n (%) | 2 | (0.3) | 2 | (0.3) | 1.00 | (0.14–7.12) | 1.000 | 0.00% |
DM, n (%) | 189 | (23.8) | 189 | (23.8) | 1.00 | (0.79–1.26) | 1.000 | 0.00% |
ESRD, n (%) | 20 | (2.5) | 20 | (2.5) | 1.00 | (0.53–1.87) | 1.000 | 0.00% |
GCS, median (IQR) | 15 | (9–15) | 14 | (14–15) | - | 0.353 | 4.66% | |
Mortality, n (%) | 147 | (18.5) | 63 | (7.9) | 2.64 | (1.93–3.61) | <0.001 | - |
Hospital stay (days) | 16.7 | ±16.2 | 12.2 | ±12.8 | - | <0.001 | - |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Huang, C.-Y.; Yen, Y.-H.; Tsai, C.-H.; Hsu, S.-Y.; Tsai, P.-L.; Hsieh, C.-H. Geriatric Trauma Outcome Score as a Mortality Predictor in Isolated Moderate to Severe Traumatic Brain Injury: A Single-Center Retrospective Study. Healthcare 2024, 12, 1680. https://doi.org/10.3390/healthcare12161680
Huang C-Y, Yen Y-H, Tsai C-H, Hsu S-Y, Tsai P-L, Hsieh C-H. Geriatric Trauma Outcome Score as a Mortality Predictor in Isolated Moderate to Severe Traumatic Brain Injury: A Single-Center Retrospective Study. Healthcare. 2024; 12(16):1680. https://doi.org/10.3390/healthcare12161680
Chicago/Turabian StyleHuang, Ching-Ya, Yuan-Hao Yen, Ching-Hua Tsai, Shiun-Yuan Hsu, Po-Lun Tsai, and Ching-Hua Hsieh. 2024. "Geriatric Trauma Outcome Score as a Mortality Predictor in Isolated Moderate to Severe Traumatic Brain Injury: A Single-Center Retrospective Study" Healthcare 12, no. 16: 1680. https://doi.org/10.3390/healthcare12161680