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Prognostic tools for the care of older adults presenting with trauma.

Risk of adverse outcomes following major trauma has traditionally been defined by the level and extent of injury, not the characteristics of the patient undergoing the trauma [1]. This approach is insufficient—not least because of the growing vulnerability, complexity and advanced age of patients presenting to hospital with trauma, who are a heterogeneous population in need of care that takes account of this complexity. Prognostic models typically combine multiple predictors to predict the risk of an individual with a particular condition or health state (the ‘startpoint’) experiencing a particular outcome event (the ‘endpoint’) [2]. Zhao et al . [3] report the development and validation of a new prognostic model—the geriatric trauma frailty index (GTFI). The GTFI aims to predict the risk of an older person who presents to hospital with trauma (startpoint) dying in hospital, and length of hospital stay (endpoints). Prognostic models may have a role in directing the acute trauma care of older people in helping clinicians identify patients who are at highest risk—and which patients may be candidates, for example, for: early transfer to a major trauma centre; escalation to critical care; geriatrician led or orthopaedic care. There are a number of strengths in the development of the GTFI, which was developed and validated using US data with a large sample size, and externally validated in a Chinese dataset. The authors used routine electronic health record data and International Classification of Disease Version 10 (ICD-10) codes for the GTFI variables so that the GTFI they have developed can be widely replicated. The key concern from a clinical perspective is whether this model should be adopted in routine clinical care [4]. To determine this, we have four key questions: