Sanjit R. Konda, MD; Hesham Saleh, BS; Jordan Gales, BS; Loveita Raymond, MD; Kenneth A. Egol, MD

Transcription

1 The Capacity of the Score for Trauma Triage in the Geriatric and Middle Aged (STTGMA) to Predict Mortality Up to One Year Following Index Hospitalization Sanjit R. Konda, MD; Hesham Saleh, BS; Jordan Gales, BS; Loveita Raymond, MD; Kenneth A. Egol, MD International Geriatric Fracture Society October 5, 2016

2 What is STTGMA? STTGMA is a mortality risk-assessment tool calculated in the ED upon admission for general and orthopaedic trauma patients aged > 55 years old Initially developed at the Carolinas Medical Center; Currently updated and utilized prospectively at NYU Jamaica Hospital Medical Center Level 1 Trauma Center NYU Tisch Hospital University Hospital, Tertiary Referral Center NYU Hospital for Joint Diseases Orthopaedic specialty hospital NYU Lutheran Medical Center Level 1 Trauma Center

3 How is STTGMA calculated? STTGMA score (0-100%) represents the risk of inpatient mortality during index hospitalization Patients first categorized by energy status of injury (low vs high) Variables Utilized in STTGMA Injury Status Health Status Functional Status Glasgow Coma Scale Charlson Comorbidity Index Ambulatory Status AIS Head/Neck Anticoagulation Use of assistive device AIS Chest Albumin Age AIS Extremity/Pelvis

4 How is STTGMA calculated? STTGMA score (0-100%) represents the risk of inpatient mortality during index hospitalization Patients first categorized by energy status of injury (low vs high) Variables Utilized in STTGMA Injury Status Health Status Functional Status Glasgow Coma Scale Charlson Comorbidity Index Ambulatory Status AIS Head/Neck Anticoagulation Use of assistive device AIS Chest Albumin Age AIS Extremity/Pelvis

5 How is STTGMA calculated? STTGMA score (0-100%) represents the risk of inpatient mortality during index hospitalization Patients first categorized by energy status of injury (low vs high) Variables Utilized in STTGMA Injury Status Health Status Functional Status Glasgow Coma Scale Charlson Comorbidity Index Ambulatory Status AIS Head/Neck Anticoagulation Use of assistive device AIS Chest Albumin Age AIS Extremity/Pelvis

6 Current Objective To investigate the efficacy of STTGMA in predicting mortality up to one year following initial hospitalization

7 Methodology Patients aged > 55 years old admitted to our level 1 trauma center with an orthopaedic extremity fracture Upon initial evaluation in the ED, STTGMA scores calculated Patients prospectively followed for one year to assess mortality outcomes

8 Results: One Month Follow-Up Follow-Up Time Energy Group # Contacted (% Followup) 1 month 326 (57%) # Deceased (%) AUROC (95% CI) High (14%) ( ) Low (12%) ( )

9 Six Month Follow-Up Follow-Up Time Energy Group # Contacted (% Followup) 6 month 268 (60%) # Deceased (%) AUROC (95% CI) High (19%) ( ) Low (16%) 0.717( )

10 Differences between Low and High- Energy 12 mo Cohort N Age (years) GCS CCI AIS Head/ Neck AIS Chest AIS Extremity/ Pelvis Anticoa gulatio n Ambulator y Status Assistive Device Albumi n ± Low ± ± ± ± 0.46 n/a n/a 1.21 ± ± 0.46 n/a 68.88± ± High 5136 ± ± ± ± ± n/a n/a 3.95±0.43

11 Twelve Month Follow-Up Follow-Up Time Energy Group # Contacted (% Followup) 12 month 131 (73%) # Deceased (%) AUROC (95% CI) High 51 7 (14%) 1.00 ( ) Low (15%) ( )

12 Survival at One Year 1% cutoff

13 Survival at One Year 5% cutoff

14 Conclusions STTGMA has the ability to predict mortality of middle-aged and geriatric fracture patients up to one year following index hospitalization STTGMA is a clinical-risk tool that can be implemented in real-time in the ED to aid long-term clinical decision making

15 Next Steps Palliative care consultations (PCC) are invaluable to both patients and hospitals, providing psychological, goal-setting, and decision-making support to patients and their families. Via STTGMA, our next step is to show that STTGMA provides objective criteria for PCC that will emphasize the importance of these consults in improving quality of care while decreasing hospital costs.

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17 Thank You