Objectives: To assess the reliability of the predicted probability of survival calculated using TRISS methodology by the UK Trauma Network for elderly patients.
Method: Analysis of 100 consecutive trauma patients 65 years and over, prospectively entered into the UK Trauma Network database from a single centre. The probability of survival (Ps) was calculated from the UK Trauma database and retrospectively related to survival, premorbid medical condition and mobility.
Results: Of 100 patients, 16 died and 84 survived. Eleven of the 16 who died and 12 of the survivors had pre-existing medical disease (ASA grade III-V) and social dependency suggesting a poor outcome, these factors being significantly associated with mortality (P < 0.005). The mean Ps for the 11 with severe medical disease who died was 0.85 (+/- 0.07) with a mean age 85 (+/- 3.5). The remaining five patients who died suffered high energy injuries, had a mean age of 70 (+/- 4.8) and a low probability of survival (Ps 0.40 +/- 0.24). The median pre-injury mobility score was 8 in patients who survived and 4.5 in those who died. Mobility score < 5 was associated with an increased mortality following admission from Trauma (P < 0.05).
Conclusions: There is a significant association between severe preexisting medical disease (ASA III-V) and death during admission for trauma. The Ps score is unrealistically high in this group of patients. A simple mobility score correlates well with outcome in this group.