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J Trauma Acute Care Surg. 2019 May 21. doi: 10.1097/TA.0000000000002382. [Epub ahead of print]

Pre-injury Palliative Performance Scale (PPS) predicts functional outcomes at 6 months in older trauma patients.

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Rutgers New Jersey Medical School, Newark, NJ USA.
Hospital of the University of Pennsylvania.



Older trauma patients have increased risk of adverse in-hospital outcomes. We previously demonstrated that low pre-injury Palliative Performance Scale (PPS) independently predicted poor discharge outcomes. We hypothesized that low PPS would predict long-term outcomes in older trauma patients.


Prospective observational study of trauma patients aged > 55 admitted between 7/2016-4/2018. Pre-injury PPS was assessed at admission; low PPS was defined as <70. Primary outcomes were mortality and functional outcomes, measured by GOSE, at discharge and 6 months. Poor functional outcomes were defined as GOSE < 4. Secondary outcomes were patient-reported outcomes at 6 months: EQ-5D and SF-36. Adjusted relative risks (aRRs) were obtained for each primary outcome using multivariable modified Poisson regression, adjusting for PPS, age, race/ethnicity, gender, and injury severity.


In-hospital data were available for 516 patients; mean age 70 years and median ISS 13. 30% had low PPS. 6% (n=32) died in hospital, and half of survivors (n=248) had severe disability at discharge. Low PPS predicted hospital mortality (aRR 2.6, 95% CI 1.2-5.3) and poor outcomes at discharge (aRR 2.0, 95% CI 1.7-2.3). Six-month data were available for 176/203 (87%) patients who were due for follow-up. Functional outcomes improved in 64% at 6 months. However, 63% had moderate to severe pain, and 42% moderate to severe anxiety/depression. Mean GOSE improved less over time in low-PPS patients (7% vs. 24%; p<0.01). Low PPS predicted poor functional outcomes at 6 months (aRR 3.1, 95% CI 1.8-5.3) while age and ISS did not.


Pre-injury PPS predicts mortality and poor outcomes at discharge and 6 months. Despite improvement in function, persistent pain and anxiety/depression were common. Low-PPS patients fail to improve over time compared to high-PPS patients. Pre-injury PPS can be used on admission for prognostication of short- and long-term outcomes and is a potential trigger for palliative care in older trauma patients.


Prognostic study - level II.

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