What Is the Geriatric Outcome Score (GTOS)?
The Geriatric Trauma Outcome Score (GTOS) is a prognostic tool used to predict in-hospital mortality for older adults (typically 65 and older) who have experienced a traumatic injury. It is designed to account for the increased vulnerability of geriatric patients and provides a quick assessment to help trauma teams make informed decisions about care and resource allocation. The GTOS relies on easily accessible variables, making it practical for emergency settings. There is also a related score, GTOS II, which aims to predict unfavorable discharge disposition for survivors.
How Is the GTOS Calculated?
The GTOS formula utilizes three variables to determine a score, with a higher score indicating a greater probability of mortality.
The GTOS Formula
- Formula: GTOS = Age + (2.5 × Injury Severity Score) + 22 (if transfused within 24 hours)
Formula Components
- Age: Used directly as a continuous variable.
- Injury Severity Score (ISS): A standardized anatomical system where scores from the three most severely injured body regions are squared and summed. This total ISS is then multiplied by 2.5 in the GTOS formula.
- Packed Red Blood Cell (PRBC) Transfusion: If the patient receives any PRBCs within 24 hours of admission, 22 is added to the score, reflecting the increased mortality risk associated with significant bleeding.
Using the GTOS in Clinical Practice
Clinicians use the GTOS to assist in various aspects of geriatric trauma care, though it should be part of a broader assessment.
Applications include:
- Prognostication: Helps healthcare providers and families understand the estimated risk of in-hospital death.
- Goals of Care Discussions: Provides objective data to support discussions about treatment options, likely outcomes, and end-of-life care.
- Triage and Resource Allocation: Acts as a rapid screening tool for risk stratification to guide interventions.
- Quality Improvement: Used by hospitals to monitor patient outcomes and evaluate trauma care protocols.
Limitations and Comparison to Other Tools
The GTOS has limitations compared to more complex scoring systems.
Comparison of Geriatric Trauma Scoring Systems
| Feature | Geriatric Trauma Outcome Score (GTOS) | Elderly Mortality After Trauma (EMAT) | Geriatric Trauma Mortality Score (GERtality) |
|---|---|---|---|
| Key Components | Age, ISS, and PRBC transfusion. | Demographics, comorbidities, injury types, physiological markers. | Age ≥ 80, PRBC transfusion, ASA score ≥ 3, GCS ≤ 13, and AIS ≥ 4. |
| Strengths | Simple and quick using easily available information. | Comprehensive variables for potentially greater accuracy. | Balances simplicity with inclusion of key “frailty” indicators. |
| Limitations | Underestimates mortality in severe TBI, lacks neurological variables/comorbidities. Accuracy decreases at very high-risk. | Requires extensive data and special software. | Age cutoff at ≥80 can be limiting; does not weight variables. |
Other GTOS Limitations
- Underestimation in Severe TBI: The GTOS often underestimates mortality risk in patients with multiple traumas including severe TBI, as it lacks neurological variables like Glasgow Coma Scale (GCS).
- Limited Scope: It primarily predicts in-hospital mortality and does not reliably indicate long-term outcomes, morbidity, or functional status. GTOS II aimed to address discharge outcomes but showed limited effectiveness.
- Calibration Issues: The model may over- or under-estimate risk, especially at very high-risk levels, suggesting calibration issues.
Conclusion
The Geriatric Trauma Outcome Score (GTOS) is a practical tool for predicting in-hospital mortality in elderly trauma patients. Its simplicity, based on age, ISS, and initial blood transfusion, makes it useful for rapid risk stratification and guiding clinical decisions and communication with families. However, its limitations, such as reduced accuracy in severe TBI and lack of inclusion of factors like comorbidities, necessitate its use as part of a comprehensive clinical assessment rather than in isolation. Considering additional clinical variables in future versions could improve its predictive power.
World Journal of Emergency Surgery Guideline on Geriatric Trauma Management
