Integrating Comorbidities in Trauma Injury Severity Scoring System: Does It Matter?
Adel Elkbuli, MD, MPH; Reed Yaras, B.S; Ahmad Elghoroury, B.S; Dessy Boneva, MD; Mark McKenney, MD, MBA; Shaikh Hai, MD, FACS
Kendall Regional Medical Center, Miami, FL
Introduction: The Revised Trauma Score combined with the Injury Severity Score (ISS) remains the mostly commonly used system for predicting trauma mortality, but this scoring systems does not account for the patient's comorbidities. The purpose of this study is to evaluate the effect of comorbidities on ISS related morality and length of stay (LOS). Study Design and
Methods: Three-year review of our trauma registry. Patients were divided by ISS into two groups: ISS=1-15, and ISS> 15. Each ISS group was then subdivided by number of comorbidities, 1-2, and ≥3. Demographic characteristics, mechanism, outcome measures including death and LOS were compared. Chi Squared and t-test were used with significance defined as p<0.05.
Results: A total 9,845 trauma patients were studied. In the ISS=1-15 group, patients with ≥3 comorbidities had significantly higher mortality rate compared to the ISS=1-15 with 1-2 comorbidities (4.0% vs 0.3%,p<0.00002). Comparing the ISS> 15 patients with ≥3 comorbidities to the ISS> 15 with 1-2 comorbidities the mortality rate was significantly higher (33% vs 7%, p<0.00006). The ICU-LOS was significantly higher in the ISS 1-15 group with ≥3 comorbidities vs 1-2 (17 vs 10 days, p<0.05) but not in the ISS> 15 groups (31 vs 29 days) (p>0.05).
Conclusion: With similarly injured patients increased comorbidities is associated with a significantly higher mortality indicating that increased number of comorbidities may serve as a marker of lower physiologic reserve and be an independent variable. Adding comorbidity parameters to the current trauma scoring systems can be assist in predicting more accurate/reliable outcomes.
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