Predictive Limitations of the Geriatric Trauma Outcome Score: A Retrospective Analysis of Mortality in Elderly Patients with Multiple Traumas and Severe Traumatic Brain Injury

Background/Objectives: The Geriatric Trauma Outcome Score (GTOS) is used to predict in-hospital mortality in geriatric patients with trauma. However, its applicability to elderly patients with multiple traumas and severe traumatic brain injury (TBI) remains poorly understood. This study aimed to evaluate the predictive accuracy of the GTOS in elderly patients with multiple traumas and TBI and assess its performance in patients with mild and severe TBI. Methods: We retrospectively analyzed 1283 geriatric multiple trauma patients (aged >= 65 years) treated at a regional trauma center from 2019 to 2023. Patients were stratified into mild (head Abbreviated Injury Scale [AIS] <= 3) and severe (head AIS >= 4) TBI groups. GTOS values were calculated for each patient, and predicted mortality was compared with in-hospital mortality. GTOS predictive accuracy was assessed by analyzing the receiver operating characteristic curve. Results: Patients had a median Injury Severity Score of 18 (interquartile range: 10-25); 33.3% of patients received red blood cell transfusions within 24 h. The overall in-hospital mortality rate was 17.9%; GTOS predicted a mortality rate of 17.6% +/- 0.17. The GTOS accurately predicted the in-hospital mortality in the entire cohort, achieving an Area Under the Curve (AUC) of 0.798. Predictive accuracy diminished for patients with severe TBI (AUC = 0.657), underestimating actual mortality (39.5% vs. 28.8% predicted). Conclusions: While the GTOS remains a useful tool for predicting in-hospital mortality in elderly patients with multiple traumas, it consistently underestimates mortality risk in those with severe TBI. Therefore, applying the GTOS in this patient subgroup warrants careful consideration.