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Background <p>Accurate early risk stratification of older trauma patients is essential for appropriate triage and resource allocation. We compared the discriminatory performance of three prognostic scores—Rapid Emergency Medicine Score (REMS), Injury Severity Score (ISS), and Glasgow Coma Scale-based Trauma Outcome Score (GTOS)—for predicting in-hospital mortality in trauma patients aged 65 years and older.</p> Methods <p>A single-center, retrospective cohort study was conducted, including all trauma patients aged 65 years or older admitted to the Emergency Department of Imam Khomeini Hospital (Sari, Iran) between September 2019 and March 2023 (<i>n</i> = 296). REMS, ISS, and GTOS were computed from registry and chart data. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC-ROC) and compared with DeLong’s test. Multivariable logistic regression models were fit to estimate adjusted associations and predictive performance. Pre-specified subgroup analyses included patients ≥ 75 years and those with ISS ≥ 9.</p> Results <p>This study examined 296 patients with trauma. Overall, in-hospital mortality was 6.0% (18/296). AUCs for predicting in-hospital mortality were: REMS 0.949 (95% CI 0.898–1.00), GTOS 0.928 (95% CI 0.881–0.949), and ISS 0.860 (95% CI 0.770–0.949). The overall difference in discrimination across scores was statistically significant (<i>p</i> = 0.031). In multivariable analysis, each one-point increase in REMS was associated with higher odds of in-hospital death (OR 1.51; 95% CI 1.45–1.58). Observed in-hospital mortality by REMS strata was: &lt;8 = 1.2%, 8–10 = 8.3%, and ≥ 11 = 70.6%. GTOS maintained superior performance in subgroup analyses than REMS, including patients aged 75 years or older and those with an ISS of 9 or higher.</p> Conclusion <p>In this cohort of older trauma patients, REMS demonstrated superior discriminatory ability for in-hospital mortality compared with GTOS and ISS, and may serve as a rapid, bedside tool to identify high-risk older trauma patients in the emergency department. External validation in larger, multi-center cohorts is recommended before broad implementation.</p>

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Trauma outcomes in elderly patients referring to the emergency department via the rapid emergency medicine score, injury severity score, and geriatric trauma outcome score indices

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月30日

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  • Farzad Bozorgi,
  • Touraj Assadi,
  • Mohammad Sazgar,
  • Fatemeh Jahanian,
  • Mohammadreza Abdollahifar,
  • Hamed Aminiahidashti

摘要

Background

Accurate early risk stratification of older trauma patients is essential for appropriate triage and resource allocation. We compared the discriminatory performance of three prognostic scores—Rapid Emergency Medicine Score (REMS), Injury Severity Score (ISS), and Glasgow Coma Scale-based Trauma Outcome Score (GTOS)—for predicting in-hospital mortality in trauma patients aged 65 years and older.

Methods

A single-center, retrospective cohort study was conducted, including all trauma patients aged 65 years or older admitted to the Emergency Department of Imam Khomeini Hospital (Sari, Iran) between September 2019 and March 2023 (n = 296). REMS, ISS, and GTOS were computed from registry and chart data. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC-ROC) and compared with DeLong’s test. Multivariable logistic regression models were fit to estimate adjusted associations and predictive performance. Pre-specified subgroup analyses included patients ≥ 75 years and those with ISS ≥ 9.

Results

This study examined 296 patients with trauma. Overall, in-hospital mortality was 6.0% (18/296). AUCs for predicting in-hospital mortality were: REMS 0.949 (95% CI 0.898–1.00), GTOS 0.928 (95% CI 0.881–0.949), and ISS 0.860 (95% CI 0.770–0.949). The overall difference in discrimination across scores was statistically significant (p = 0.031). In multivariable analysis, each one-point increase in REMS was associated with higher odds of in-hospital death (OR 1.51; 95% CI 1.45–1.58). Observed in-hospital mortality by REMS strata was: <8 = 1.2%, 8–10 = 8.3%, and ≥ 11 = 70.6%. GTOS maintained superior performance in subgroup analyses than REMS, including patients aged 75 years or older and those with an ISS of 9 or higher.

Conclusion

In this cohort of older trauma patients, REMS demonstrated superior discriminatory ability for in-hospital mortality compared with GTOS and ISS, and may serve as a rapid, bedside tool to identify high-risk older trauma patients in the emergency department. External validation in larger, multi-center cohorts is recommended before broad implementation.