Use of the STTGMA Tool to Risk Stratify 1-Year Functional Outcomes and Mortality in Geriatric Trauma Patients

J Orthop Trauma. 2018 Sep;32(9):461-466. doi: 10.1097/BOT.0000000000001242.


Objectives: To determine whether a novel inpatient mortality risk assessment tool designed to be calculated in the emergency department setting can risk stratify patient-reported functional outcomes and mortality at 1 year.

Design: Prospective cohort.

Setting: Academic level 1 trauma center.

Patients: Six hundred eight-five patients >55 years of age who were orthopaedic surgery consults or trauma surgery consults in the emergency department between January 10, 2014, and September 30, 2015.

Intervention: Calculation of the validated score for trauma triage in the geriatric and middle-aged (STTGMA) using each patient's demographics, injury severity, and functional status.

Main outcome measurements: Mortality, EQ-5D questionnaire, and percent return to baseline function since their hospitalization at 1-year after hospitalization.

Results: Forty-five (6.6%) patients died within the year after hospitalization. Of remaining 639 patients available for follow-up, 247 (38.7%) were successfully contacted. There was no observed difference between patients who were successfully contacted and those who were not. The mean STTGMA score was 2.1% ± 3.6%. Patients reported on average a 76.4% ± 27.5% return to baseline function. When comparing patients between risk groups, there was a significant difference in EQ-5D scores and percent return to baseline. The Kaplan-Meier survival curve shows that high-risk patients had pronounced decreased survival within the initial days after discharge compared with other cohorts.

Conclusions: This study demonstrates that patients identified with the STTGMA tool as having an increased risk of inpatient mortality after trauma correlate with poorer functional outcomes at 1 year. The STTGMA risk score is also a valuable tool to stratify risk of mortality up to 1 year after discharge.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Academic Medical Centers
  • Activities of Daily Living*
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Databases, Factual
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Geriatric Assessment / methods*
  • Hospital Mortality / trends*
  • Humans
  • Male
  • Middle Aged
  • Orthopedic Procedures / methods
  • Orthopedic Procedures / mortality*
  • Prospective Studies
  • Recovery of Function
  • Risk Assessment
  • Survival Analysis
  • Time Factors
  • Trauma Centers
  • Trauma Severity Indices
  • Treatment Outcome
  • Triage
  • United States
  • Wounds and Injuries / diagnostic imaging
  • Wounds and Injuries / mortality*
  • Wounds and Injuries / surgery*