Comparison of nutritional and trauma scores in older trauma patients presenting to the emergency department

BACKGROUND: This study evaluated trauma severity and nutritional status scores in older trauma patients aged ≥ 60 years presenting to the emergency department, comparing their ability to predict mortality and to evaluate the prognostic significance of malnutrition. METHOD: A retrospective cohort study was conducted including patients aged ≥ 60 years admitted to the ICU following trauma. Trauma severity was assessed using the Revised Trauma Score (RTS) and Injury Severity Score (ISS), while nutritional status was evaluated using the Nutritional Risk Score-2002 (NRS-2002), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT). Physiological severity was assessed using the Acute Physiology and Chronic Health Evaluation Score (APACHE II). Multivariate logistic regression and ROC curve analyses were performed to identify predictors of mortality and assess predictive accuracy. RESULTS: The study included 304 patients; 34.9% were women, with a mean age of 71.9 ± 9.5 years. The overall mortality rate was 25.3%. Deceased patients had lower GNRI scores and higher NRS-2002 and APACHE II scores (p < 0.001, p < 0.001, p < 0.001, respectively). In terms of trauma severity, ISS was higher and RTS was lower in patients who died compared with survivors (p < 0.001, p < 0.001). In the multivariate analysis, APACHE II and ISS remained independent predictors of in-hospital mortality, whereas nutritional scores (GNRI), age, and sex were not independently associated with mortality. RTS showed the highest AUC (0.907) on ROC analysis, whereas APACHE II, NRS-2002, CONUT, ISS, and GNRI demonstrated lower discriminatory performance (all p < 0.05). CONCLUSION: Trauma severity significantly impacted in-hospital mortality in older trauma patients, whereas nutritional status did not demonstrate an independent association with mortality.