Comparing Comorbidity Polypharmacy Score and Charlson Comorbidity Index in predicting outcomes in older trauma patients. Issue 4 (April 2023)

• Record Type: Journal Article
• Authors: Chua, Mui Teng; Pan, Darius Shaw Teng; Lee, Ming Zhou; Thajudeen, Mohammed Zuhary; Rahman, Mohamed Madeena Faizur; Sheth, Irfan Abdulrahman; Ong, Victor Yeok Kein; Tang, Jonathan Zhe Ying; Wee, Choon Peng Jeremy; Kuan, Win Sen
• Is Part Of: Injury. Volume 54:Issue 4(2023)
• Page Start: 1113
• Page End: 1118
• Publication Date: 2023-04
• Subjects: Geriatric trauma -- Polypharmacy -- Trauma severity indices -- Mortality; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2023.02.031
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: This is the largest study to-date comparing the utility of CCI and CPS in predicting mortality and discharge outcomes in older trauma patients. CCI, but not CPS, predicts mortality in older patients with trauma. Increasing CCI decreased odds of discharge to care facilities. Predictive scoring system that incorporates injury severity, comorbidities and polypharmacy is needed. Abstract: Background: The Charlson Comorbidity Index (CCI) and Comorbidity Polypharmacy Score (CPS) may potentially risk-stratify older trauma patients more accurately than traditional trauma severity scores. We aim to evaluate if CCI or CPS are better predictors of mortality and discharge venue in such patients. Methods: We conducted a retrospective study using registry data from two tertiary trauma centres. Patients aged 65 years and above who presented to the emergency departments (EDs) between January 2011 and December 2015 with traumatic injuries were included. Charts were reviewed for demographics, injury mechanism and severity, discharge outcomes, and types of comorbidities and medications used. Primary outcome was overall mortality; secondary outcomes included ED disposition and hospital discharge venue. Discriminatory power of the score(s) were compared using area under the receiver operating characteristic (AUROC) curve. Results: There were 2, 750 patients, with overall female predominance (56.7%, 1, 560/2, 750) and median age of 78 years (interquartile range [IQR] 72 to 84 years). Median CCI score was 1 (IQR 0 to 2) and median CPS was 8 (IQR 4 to 12). Overall mortality was 9.4% (259/2, 750). Every 1-point increase in CCI score resulted in increased odds of death by 16% (adjusted odds ratio 1.16, 95% confidence interval 1.07 to 1.26, p<0.001). Addition of CCI to the Injury Severity Score (ISS) increased the discriminatory power for mortality (AUROC for ISS = 0.832; AUROC for ISS with CCI = 0.843). Every 1-point increase in CCI was significantly associated with decreased odds of admission to a rehab facility by 8%. CPS did not predict mortality and discharge venue. Conclusion: CCI, but not CPS, was a predictor of mortality. A higher CCI was associated with decreased odds of discharge to a subacute facility, likely related to underlying rehabilitation potential. Further studies should be undertaken to explore an integrated scoring system that considers injury severity, comorbidities, and polypharmacy.