Multivariate Associations Between the Geriatric Trauma Outcome Score (GTOS) and Injury Characteristics in the Geriatric Trauma Population.

Background Trauma in geriatric populations represents a growing public health concern associated with elevated morbidity and mortality. The Geriatric Trauma Outcome Score (GTOS) is a widely used trauma severity metric developed to estimate clinical risk and in-hospital mortality among elderly trauma patients. It incorporates patient age, Injury Severity Score (ISS), and packed red blood cell (PRBC) transfusion status within 24 hours of admission. Although GTOS has shown clinical utility in geriatric trauma populations, limited literature has characterized the demographic and injury-related factors associated with elevated GTOS values in hospitalized patients. Methods This retrospective cohort study included patients aged ≥65 years admitted to a Level 1 trauma center in New York City between November 2024 and December 2025. Study variables encompassed demographics, body mass index (BMI), anticoagulation status, Glasgow Coma Score (GCS), mechanism of injury, and primary injury diagnosis. Descriptive statistics, univariate analyses, quartile stratification, and multivariable linear regression modeling were performed to identify factors associated with elevated GTOS values. Exploratory mortality analysis was conducted using the Firth penalized logistic regression, given the low frequency of mortality events. Results A total of 687 patients were included in the final analytic cohort. The mean patient age was 79.3 ± 8.4 years, and mean GTOS was 92.2 ± 15.6. Traumatic brain injuries (TBIs) and head injuries together represented the most prevalent diagnostic category (36.2%, n=249). In multivariable linear regression analysis, lower BMI, anticoagulation use, motor vehicle collisions, and selected injury diagnoses were significantly associated with GTOS values. Exploratory Firth penalized logistic regression demonstrated significant associations between mortality and both GTOS (OR 1.04, 95% CI 1.02-1.07, p=0.003) and GCS (OR 0.77, 95% CI 0.62-0.98, p=0.036). Conclusion Several demographic and injury-related factors, including lower BMI, anticoagulation use, motor vehicle collisions, and selected injury diagnoses, were significantly associated with GTOS values among hospitalized geriatric trauma patients. Higher GTOS values and lower GCS scores were each independently associated with mortality in exploratory analysis. These findings further characterize the clinical profile of geriatric trauma patients with elevated GTOS and support the continued utility of this score in clinical management settings.