Abstract
Here we conducted a retrospective analysis of hospital-based trauma registry database for evaluating the impacts of comorbidities on the prognosis for traumatized patients using Index of Coexistent Comorbidity Disease (ICED) scores. We analyzed the data of patients with blunt trauma who visited emergency department between January 1, 2011, and December 31, 2015 in Chang-Gung Memorial Hospital, Keelung branch, a single level I trauma center in the Northern Taiwan. All consecutive patients with blunt trauma who admitted to the intensive care unit or ordinary ward after initial managements in the emergency department were included. We measured the hospital mortality of blunt traumatized patients using alive discharge as a competing risk. To investigate conditional independence of mortality and ICED scores given Injury Severity Score (ISS), we used log-linear models for modeling independence structures. Overall, we included 4997 patients (median age [IQR], 59 years old (44–75 years); 55.3% male). The mortality rate of blunt traumatized patients was higher in the higher ICED scores group compared to lower ICED scores group (4.7% vs 1.8%, p < 0.001). Meanwhile, the higher ICED scores group were associated with older age, higher ISS, and longer hospital stay than lower ICED scores group. Higher ICED group had higher probability of transition-to-death and lower probability of transition-to-discharge under the competing risk model. In the multivariable analysis of transition-specific Cox models, higher ICED group were associated with higher risk for hospital mortality compared to lower ICED group (HR 1.60; [95% CI 1.04–2.47]; p = 0.032). Also, higher ICED group were associated with lower probability of transition-to-discharge (HR 0.79; [95%CI 0.73–0.86]; p < 0.001). Additionally, higher ICED scores accounted for hospital mortality among patients with ISS < 25. In conclusion, our study suggested that severity of comorbidity was associated with higher hospital mortality among traumatized patients, particularly lower ISS.
Highlights
Traumatic injury remains a major global public health problem and is associated with massive losses of health and life
All patients with blunt traumatic injury who were admitted to the intensive care unit or ordinary ward after primary surveillance in the emergency department were enrolled in this study; patients with penetrating injuries, burns, out-hospital cardiac arrest (OHCA), an incomplete medical history, an age younger than 20 years, and discharge or death within 24 hours of admission were excluded
We used the Index of Coexistent Comorbidity Disease (ICED) score to evaluate comorbidities [19, 20]. This score is derived from two separate assessments: the Index of Disease Severity (IDS), which comprises 19 medical conditions, and the Index of Physical Impairment (IPI), which comprises 11 physical impairments
Summary
Traumatic injury remains a major global public health problem and is associated with massive losses of health and life. Advances in trauma care systems and vehicle and environmental safety have led to recent decreases in the overall mortality rate associated with trauma, diseases related to pre-existing diseases have increased significantly among elderly trauma patients [3,4,5]. In Taiwan, the median age of trauma patient increased from 46 years in 2001 to 60 years in 2014 [2]. Given this trend toward population aging, trauma care systems are faced with challenges related to the pre-existing comorbidities and impaired physiological reserves of elderly patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
