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Enhancing Utility of Interfacility Triage Guidelines Using Machine Learning: Development of the Geriatric Interfacility Trauma Triage Score (GITTS).

BACKGROUND
Under-triage of injured older adults to tertiary trauma centers (TTCs) has been demonstrated by many studies. In predominantly rural regions, a majority of trauma patients are initially transported to non-tertiary trauma centers (NTCs). Current inter-facility triage guidelines do not highlight the hierarchical importance of risk factors nor do they allow for individual risk prediction. We sought to develop a transfer risk score that may simplify secondary triage of injured older adults to TTCs.


METHODS
This was a retrospective prognostic study of injured adults > = 55 years initially transported to an NTC from the scene of injury. The study utilized data reported to the Oklahoma State Trauma Registry between 2009 and 2019. The outcome of interest was either mortality or serious injury (ISS > =16) requiring an interventional procedure at the receiving facility. In developing the model, machine-learning techniques including random forests were used to reduce the number of candidate variables recorded at the initial facility.


RESULTS
Of the 5913 injured older adults initially transported to an NTC before subsequent transfer to a TTC, 32.7% (1696) had the outcome of interest at the TTC. The final prognostic model (AUC, 75.4%; 95% CI: 74-76%) included the following top four predictors and weighted scores: airway intervention (10), traffic-related femur fracture (6), spinal cord injury (5), ED GCS < =13 (5), and hemodynamic support(4). Bias-corrected and sample validation AUCs were 74% and 72% respectively. A risk score of 7 yields a sensitivity of 78% and specificity of 56%.


CONCLUSION
Secondary triage of injured older adults to tertiary trauma centers could be enhanced by use of a risk score. Our study is the first to develop a risk stratification tool for injured older adults requiring transfer to a higher level of care.


LEVEL OF EVIDENCE
Prognostic, Level II.