TS-2026-008

With the aging population, geriatric trauma cases -particularly injuries resulting from high-energy traffic accidents- have become a major cause of morbidity and mortality. Older patients are considerably more vulnerable to acute traumatic stressors because of diminished physiological reserves, a high burden of comorbidities, polypharmacy, and anticoagulant therapy. This physiological vulnerability may result in a clinical course that is more complex and less predictable than that observed in younger patients and may lead to adverse outcomes even in injuries that initially appear minor. Although conventional trauma scoring systems, such as the Injury Severity Score (ISS), New Injury Severity Score (NISS), and Trauma and Injury Severity Score (TRISS), are also used in geriatric populations, their predictive performance in older patients remains controversial. This is because these conventional systems do not fully account for age-related physiological frailty or laboratory abnormalities reflecting acute metabolic status. This represents a clinically important gap, as prognosis is directly influenced not only by the mechanism of injury but also by the patient’s pre-injury frailty, acute physiological response, and laboratory findings. Accordingly, this study aimed to simultaneously and comprehensively evaluate the predictive performance of conventional trauma scores, frailty assessed using the Clinical Frailty Scale (CFS), and acute laboratory markers such as lactate and the international normalized ratio (INR) for 30-day mortality among geriatric patients presenting to the emergency department with blunt trauma. By improving risk stratification in this vulnerable patient population, the study seeks to provide clinical guidance for early management and emergency department resource allocation.

The primary aim of this study is to determine the independent and combined effects of antithrombotic medication use and frailty level on 30-day mortality in patients aged 65 years and older presenting to the emergency department with blunt trauma. A comprehensive comparison will be conducted among different antithrombotic treatment groups -patients not receiving antithrombotic therapy, those receiving antiplatelet therapy, and those receiving anticoagulant therapy- as well as among patients with different levels of frailty. Accordingly, the need for hospitalization, requirement for emergency surgical intervention, 30-day hospital readmissions after discharge, and post-discharge care needs will be monitored as the main outcome measures. The study also aims to clarify how the clinical course of geriatric trauma patients is influenced not only by injury severity scores but also by their existing physiological reserve and medication-related risks.

The study was designed as a multicenter, prospective, observational cohort study investigating the clinical course and outcomes of patients aged 65 years and older presenting to emergency departments with blunt trauma. All eligible patients presenting to the emergency department will be enrolled. At presentation, demographic characteristics, mechanism and severity of trauma -as assessed using the Injury Severity Score (ISS)- and vital signs, including heart rate, respiratory rate, and blood pressure, will be recorded. Pre-injury antithrombotic medication use, including antiplatelet and anticoagulant therapy, will be documented, and frailty will be assessed using the Clinical Frailty Scale (CFS). Following clinical examination, diagnostic evaluation, and treatment, hospitalization, need for surgical intervention, and discharge status will be recorded. Subsequently, structured telephone interviews will be conducted on day 30 to determine survival status, emergency department revisits or hospital readmissions, and the development of post-discharge care needs. Clinical Frailty Scale (CFS): The CFS is a clinician-assessed tool that rates patients’ pre-injury functional status from 1 (very fit) to 9 (terminally ill). It has demonstrated high validity and inter-rater reliability in predicting mortality and complications in geriatric populations and is recommended by international guidelines, including those of the American College of Surgeons (ACS) and the World Society of Emergency Surgery (WSES). Injury Severity Score (ISS): The ISS will be used to objectively quantify injury severity. It has been shown to have excellent discriminatory ability for predicting 30-day mortality among geriatric road traffic injury patients (area under the curve [AUC] >0.99). Tests and investigations: No study-specific laboratory tests or radiological imaging procedures will be performed. At presentation, the CFS and ISS will be assessed and documented by the treating physician. For patients undergoing laboratory testing or imaging based on the mechanism of injury and clinical examination findings, platelet counts, international normalized ratio (INR) levels, and abnormal imaging findings will be included as study data. Inclusion criteria: Presentation to the emergency department of a participating center because of blunt trauma; age 65 years or older; agreement to participate in the study; and availability of reliable information regarding the patient’s current medications. Exclusion criteria: Inability to obtain informed consent; penetrating trauma or burn injuries; inability to calculate the CFS or ISS; inability to determine medication use; age younger than 65 years; or refusal to be contacted for follow-up on day 30 after the trauma.

Gözlemsel Çalışma Dizaynı / Prospective