When counseling surrogates of massively injured elderly trauma patients the prognostic information they desire is rarely evidence based. to predict futility in massively injured elderly trauma patients. Future attempts to predict futility in these age groups may benefit from incorporating measures of physiologic distress. Introduction When counseling families of the massively injured the conversation centers around the familial question “Will my loved one survive?” When having these conversations about elderly trauma patients it has been our group’s anecdotal experience that family members often overestimate the hope of recovery in this cohort.1 Physicians have an ethical obligation to the patient and a practical obligation to their medical system and its finite resources to determine when further aggressive efforts at care after traumatic injury are futile. While few would argue with the importance of the determination of futility after geriatric injury this decision is usually made subjectively based on the provider’s experience rather than being driven by evidence. The paucity of promulgated guidelines for elderly trauma is surprising given the widespread acceptance of an age-incorporated futility model after thermal injury (i.e. the Baux Score2 3 The need for such a predictive tool after nonthermal injury becomes especially evident when considering that the elderly population is projected SB-742457 to constitute >20% of the population by the year 2040.4 Previous studies have performed large data bank analysis to predict mortality in the elderly but have not gained widespread acceptance.5 Our goal with this study was to create a simplified model that could reliably predict futility of care in the elderly trauma patient based on assessment of easily obtainable bedside clinical factors age preinjury comorbidities and the patient’s Injury Severity Score (ISS). It was our a priori hypothesis that threshold combinations of these scores existed that would correlate with mortality rates of 80% 95 99 and 100% (in order to accommodate a spectrum of potential definitions of futility of SB-742457 care). Methods This study was an IRB-approved retrospective review utilizing the National Trauma Data Bank (NTDB) from the American College of Surgeons Committee on Trauma the largest aggregate trauma registry data from accredited trauma centers in the United States. We queried the NTDB between the years 2007 and 2011 for all patients aged 70 or older. The sample was then divided to create two age cohorts: those aged 70 to 79 years and those aged 80 years and older. The ISS has been used as a method to quantitatively assign a score to the magnitude of injury since its description in the 1970s.6 A score of 0 (uninjured) to 5 (massively injured) is assigned to six different body areas and the ISS is obtained by squaring all injured areas and summing the squares of the three worst scores. ISS scores can therefore range from 0 for an uninjured person to a maximum of 75 (52+52+52=75). This data is ordinal and the range of scores are not consecutive (i.e. the ISS that is the next highest to the maximum of 75 is the sum of 52+52+42 or 66). Finally an important exception to this general rule of ISS calculation lies in a set of predefined injuries which are considered untreatable (i.e. decapitation) and these injuries have a body area score of 6 and an automatic overall ISS of 75 regardless of what other body areas may have been injured. Due to the fact that family discussions for these patients with untreatable injuries are moot we chose to exclude all subjects with an ISS score of 75 from our analysis. We then began by calculating overall mortality for each individual ISS score without consideration of comorbidities. The NTDB during the years in question tracked 27 different preinjury comorbidities. Two Rabbit Polyclonal to USP15. were excluded due to nonapplicability to a geriatric cohort (prematurity and congenital anomalies) and two due to their lesser impact on outcomes (hypertension SB-742457 requiring medication and smoking). “Presence of an advanced directive limiting care” was excluded due to its potential confounding effect by causing death despite SB-742457 a medically survivable injury. This left 22 comorbidities for inclusion in the analysis (see Table 1). The two age cohorts were SB-742457 then further subdivided by grouping the patients as having 0 1 or ≥2 of these comorbid conditions. Table 1. National.