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
Dublin Core
Title
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
score, and geriatric trauma outcome score indices
Subject
Geriatric trauma, Rapid emergency medicine score, Injury severity score, Geriatric trauma outcome score
Description
Abstract
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
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
Creator
Farzad Bozorgi1,2, Touraj Assadi1,3, Mohammad Sazgar1
, Fatemeh Jahanian1
, Mohammadreza Abdollahifar4
and
Hamed Aminiahidashti1,5*
, Fatemeh Jahanian1
, Mohammadreza Abdollahifar4
and
Hamed Aminiahidashti1,5*
Source
https://doi.org/10.1186/s12245-025-01046-4
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Farzad Bozorgi1,2, Touraj Assadi1,3, Mohammad Sazgar1
, Fatemeh Jahanian1
, Mohammadreza Abdollahifar4
and
Hamed Aminiahidashti1,5*, “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,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12883.
score, and geriatric trauma outcome score indices,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12883.