Enhancing geriatric trauma mortality prediction: Modifying and assessing the Geriatric Trauma Outcome Score with net benefit and decision curve analysis
Article Swipe
Pawan Acharya
,
Tabitha Garwe
,
Sara K. Vesely
,
Amanda E. Janitz
,
Jennifer D. Peck
,
Alisa Cross
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1111/acem.15103
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1111/acem.15103
Objective Calibration and discrimination indicators alone are insufficient for evaluating the clinical usefulness of prediction models, as they do not account for the cost of misclassification errors. This study aimed to modify the Geriatric Trauma Outcome Score (GTOS) and assess the clinical utility of the modified model using net benefit (NB) and decision curve analysis (DCA) for predicting in‐hospital mortality. Methods The Trauma Quality Improvement Program (TQIP) 2017 was used to identify geriatric trauma patients (≥ 65 years) treated at Level I trauma centers. The outcome of interest was in‐hospital mortality. The GTOS was modified to include additional patient, injury, and treatment characteristics identified through machine learning methods, focusing on early risk stratification. Calibration and discrimination indicators, along with NB and DCA, were utilized for evaluation. Results Of the 67,222 admitted geriatric trauma patients, 5.6% died in the hospital. The modified GTOS score included the following variables with associated weights: initial airway intervention (5), Glasgow Coma Scale ≤13 (5), packed red blood cell transfusion within 24 h (3), penetrating injury (2), age ≥ 75 years (2), preexisting comorbidity (1), and torso injury (1), with a total range from 0 to 19. The modified GTOS demonstrated a significantly higher area under the curve (0.92 vs. 0.84, p < 0.0001), lower misclassification error (4.9% vs. 5.2%), and lower Brier score (0.036 vs. 0.042) compared to the original GTOS. DCA showed that using the modified GTOS for predicting in‐hospital mortality resulted in higher NB than treating all, treating none, and treating based on the original GTOS across a wide range of clinician preferences. Conclusions The modified GTOS model exhibited superior predictive ability and clinical utility compared to the original GTOS. NB and DCA offer valuable complementary methods to calibration and discrimination indicators, comprehensively evaluating the clinical usefulness of prediction models and decision strategies.
Related Topics
Concepts
Medicine
Geriatric trauma
Glasgow Coma Scale
Emergency medicine
Injury Severity Score
Revised Trauma Score
Receiver operating characteristic
Internal medicine
Poison control
Injury prevention
Surgery
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1111/acem.15103
- OA Status
- hybrid
- Cited By
- 4
- References
- 54
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4407223603
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4407223603Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1111/acem.15103Digital Object Identifier
- Title
-
Enhancing geriatric trauma mortality prediction: Modifying and assessing the
Geriatric Trauma Outcome Score with net benefit and decision curve analysisWork title - Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-02-06Full publication date if available
- Authors
-
Pawan Acharya, Tabitha Garwe, Sara K. Vesely, Amanda E. Janitz, Jennifer D. Peck, Alisa CrossList of authors in order
- Landing page
-
https://doi.org/10.1111/acem.15103Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
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https://doi.org/10.1111/acem.15103Direct OA link when available
- Concepts
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Medicine, Geriatric trauma, Glasgow Coma Scale, Emergency medicine, Injury Severity Score, Revised Trauma Score, Receiver operating characteristic, Internal medicine, Poison control, Injury prevention, SurgeryTop concepts (fields/topics) attached by OpenAlex
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4Total citation count in OpenAlex
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2025: 4Per-year citation counts (last 5 years)
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54Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.Conclusions | 261 |
| abstract_inverted_index.Improvement | 65 |
| abstract_inverted_index.calibration | 286 |
| abstract_inverted_index.comorbidity | 178 |
| abstract_inverted_index.evaluation. | 126 |
| abstract_inverted_index.indicators, | 117, 289 |
| abstract_inverted_index.penetrating | 169 |
| abstract_inverted_index.preexisting | 177 |
| abstract_inverted_index.strategies. | 300 |
| abstract_inverted_index.transfusion | 164 |
| abstract_inverted_index.demonstrated | 195 |
| abstract_inverted_index.insufficient | 8 |
| abstract_inverted_index.intervention | 153 |
| abstract_inverted_index.preferences. | 260 |
| abstract_inverted_index.complementary | 283 |
| abstract_inverted_index.in‐hospital | 59, 90, 236 |
| abstract_inverted_index.significantly | 197 |
| abstract_inverted_index.discrimination | 4, 116, 288 |
| abstract_inverted_index.characteristics | 103 |
| abstract_inverted_index.comprehensively | 290 |
| abstract_inverted_index.stratification. | 113 |
| abstract_inverted_index.misclassification | 26, 210 |
| cited_by_percentile_year.max | 98 |
| cited_by_percentile_year.min | 97 |
| corresponding_author_ids | https://openalex.org/A5059763902 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 6 |
| corresponding_institution_ids | https://openalex.org/I32389192, https://openalex.org/I49332381 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/16 |
| sustainable_development_goals[0].score | 0.5400000214576721 |
| sustainable_development_goals[0].display_name | Peace, Justice and strong institutions |
| citation_normalized_percentile.value | 0.98531879 |
| citation_normalized_percentile.is_in_top_1_percent | True |
| citation_normalized_percentile.is_in_top_10_percent | True |