Using Information on Preexisting Conditions to Predict Mortality From Traumatic Injury

Abstract

Preexisting conditions have been found to be an independent predictor of mortality after trauma. However, no consensus has been reached as to what indicator of preexisting condition status should be used, and the contribution of preexisting conditions to mortality prediction models is unclear. This study aims to identify the most accurate way to model preexisting condition status to predict inhospital trauma mortality and to evaluate the potential gain of adding preexisting condition status to a standard trauma mortality prediction model. The study comprised all patients from the trauma registries of 4 Level I trauma centers. Information provided by individual preexisting conditions was compared to 3 commonly used summary measures: (1) absence/presence of any preexisting condition, (2) number of preexisting conditions, and (3) Charlson Comorbidity Index. The impact of adding preexisting condition status to 2 baseline risk models, the current standard Trauma and Injury Severity Score model and an improved model based on nonparametric transformations of quantitative variables, was evaluated by the area under the receiver operating characteristics curve. Discrimination for predicting mortality in the improved model was as follows: baseline risk model: area under the receiver operating characteristics curve=0.935; baseline risk model+individually modeled preexisting conditions: area under the receiver operating characteristics curve=0.941; baseline risk model+presence of any preexisting condition: area under the receiver operating characteristics curve=0.937; baseline risk model+number of preexisting conditions: area under the receiver operating characteristics curve=0.939; baseline risk model+Charlson Comorbidity Index: area under the receiver operating characteristics curve=0.938. Preexisting condition status is an independent predictor of mortality from trauma that provides a modest improvement in mortality prediction. The total number of preexisting conditions is a good summary measure of preexisting condition status. The Charlson Comorbidity Index is no better than the total number of preexisting conditions and is therefore not recommended for use in trauma mortality modeling.