Validation of a Geriatric Trauma Prognosis Calculator: A P.A.L.Li.A.T.E. Consortium Study

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, Herb A. Phelan

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background/Objectives: The 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. Design: Retrospective cohort. Setting: Four geographically diverse Level 1 trauma centers. Participants: Trauma admissions aged 65 to 102 years surviving to discharge from 2000 to 2013. Intervention: None. Measurements: Age, 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. Results: The 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. Conclusion: GTOS 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.

Original languageEnglish (US)
Pages (from-to)2302-2307
Number of pages6
JournalJournal of the American Geriatrics Society
Issue number10
StatePublished - Oct 2017
Externally publishedYes


  • elderly
  • geriatric
  • outcomes
  • prognosis calculator
  • scoring system
  • trauma

ASJC Scopus subject areas

  • Geriatrics and Gerontology


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