Predictors of 30-day mortality in older adults with traffic-related injuries: Classical trauma scores, frailty, and laboratory markers in a retrospective study

Older adults are more vulnerable to trauma because of reduced physiological reserve, a higher burden of comorbidities, and increased frailty. However, traditional trauma scoring systems may not fully reflect these age-related factors. This study aimed to evaluate the predictive performance of classical trauma scoring systems and to examine the association of frailty and selected laboratory markers with 30-day mortality among older adults with traffic-related injuries. This retrospective study included patients aged ≥65 years who presented to a tertiary emergency department with traffic-related injuries between 2021 and 2024. Demographic, clinical, and laboratory data were recorded, along with frailty status assessed using the Clinical Frailty Scale (CFS). Trauma severity was evaluated using the Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS), Revised Trauma Score (RTS), Glasgow Age Pressure (GAP), Mechanism Glasgow Age Pressure (MGAP), and the Geriatric Trauma Outcome Score (GTOS). The primary outcome was 30-day mortality. Receiver operating characteristic (ROC) analysis and univariate logistic regression were performed to identify predictors of mortality. Among 325 patients (mean age: 73.4 years; 64.9% male), 30-day mortality was 4.9%. Chronic kidney disease was the only comorbidity significantly associated with mortality (OR: 7.69; P = .005). Mortality was associated with higher INR, lactate, and creatinine levels; lower platelet counts, Glasgow Coma Scale (GCS) scores, and systolic blood pressure; and increased respiratory rate. ISS, TRISS, and NISS demonstrated the highest discriminatory power (AUC > 0.99). Among laboratory parameters, lactate showed the strongest predictive performance (AUC = 0.910). In multivariate analysis, increased respiratory rate and higher NISS remained the only independent predictors of 30-day mortality. In this cohort of older adults with traffic-related trauma, increased respiratory rate and higher NISS were the main independent predictors of 30-day mortality. Frailty assessed by the Clinical Frailty Scale was not independently associated with short-term mortality. These findings suggest that, in high-energy traffic-related trauma, injury severity and acute physiological response may be more decisive for short-term outcomes than frailty status alone.