New England Surgical Society

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Geriatric Trauma Patients Are Not Just Older Adults: The Need For A Geriatric Specific Injury Severity Score Scale
*Carmen Fahlen, *Andrew H Stephen, *Carla C Moreira, Daithi S Heffernan
Department of Surgery, Brown University, Providence, RI

Objective: We previously identified that trauma standards including hemodynamics, shock and inflammatory markers are unreliable among aging trauma populations. The trauma Injury Severity Score (ISS) predicts mortality based on severity of injury. We hypothesize that ISS is unreliable among geriatric trauma patients.
Design: Charts were reviewed for demographics, injuries, hospital course and outcomes. Mortality was calculated for each ISS point in both young and geriatric. Lines of best fit binning points below and above each ISS were generated. Slopes of lines of best fit were calculated and inflection points, noting significant changes in mortality, generated. Setting: Level1 Trauma center 10yr retrospective review of ISS. Patients: Young(17-35yr) and Geriatric(>/=65yr) blunt trauma victims. Interventions: N/A
Main Outcome Measures: ISS and mortality
Results: There were 7,712 geriatric and 6,501 young patients. The standard ISS categories of mild(0-14), moderate(15-25) and severe(>/=25) were applied to young and geriatric patients. Mortality was higher among geriatric patients overall (10.2% versus 4.9%;p<0.001) as well as for each ISS category. Lines of best fit identified that traditional ISS cut points do not reliably predict mild, moderate and severe injury profiles among geriatric patients. Inflection points identified that mortality risk transitioned from mild (ISS=0-8) to moderate risk at ISS=8 among geriatric patients rather than15 identified among young patients. Inflection point of moderate to severe was 14. This generated the geriatric ISS(gISS) categories of mild(0-8), moderate(9-14) and severe(15-24). ISS of >/=25 among geriatric patients was almost universally fatal.
Conclusions: Previously defined mild, moderate and severe ISS do not apply to geriatric trauma patients. We have identified more appropriate cut points for degree of injury which will guide realistic recovery expectations and end of life discussions.


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