Development and validation of the mortality risk for trauma comorbidity index

Hilaire J. Thompson, Frederick P. Rivara, Avery Nathens, Jin Wang, Gregory Jurkovich, Ellen J. MacKenzie

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective: The aim of this study was to develop and validate a comorbidity index to predict the risk of mortality associated with chronic health conditions following a traumatic injury. Summary background data: Currently available comorbidity adjustment tools do not account for certain chronic conditions, which may influence outcome following traumatic injury or they have not been fully validated for trauma. Controlling for comorbidity in trauma patients is becoming increasingly important as the population ages and elderly patients are more active, as well as to adjust for bias in trauma mortality studies. Methods: Cohort study using data from the National Study on the Costs and Outcome of Trauma. Subject pool (N = 4644/Weighted Number = 14,069) was randomly divided in half; the first half of subjects was used to derive the risk scale, the second to validate the instrument. To construct the Mortality Risk Score for Trauma (MoRT), univariate analysis and odds ratios were performed to determine relative risk of mortality at hospital discharge comparing those persons with a comorbid condition to those without. Conditions significantly associated with mortality (P < 0.05) were included in the multivariate model. The variables in the final model were used to build the MoRT. The predictive ability of the MoRT and the Charlson Comorbidity Index (CCI) for discharge and 1-year mortality were estimated using the c-statistic in the validation sample. Results: Six comorbidity factors were independently associated with the risk of mortality and formed the basis for the MoRT: severe liver disease, myocardial infarction, cerebrovascular disease, cardiac arrhythmias, dementia, and depression. The MoRT had a similar overall discrimination as the CCI for mortality at hospital discharge in injured adults (c-statistic: 0.56 vs. 0.56) although neither by itself performed well. The addition of age and gender improved the predictive ability of the MoRT (0.59; 95% CI: 0.56, 0.62) and the CCI (0.59; 0.56, 0.62). Similar results were seen at 1-year postinjury. The further addition of Injury Severity Score significantly improved the predictive ability of the MoRT (0.77, 95% CI: 0.74, 0.79) and the CCI (0.77, 95% CI: 0.75, 0.80). Conclusions: The MoRTs primary advantage over current instruments is its parsimony, containing only 6 items. In the present study, the comorbid conditions found to be predictive of mortality had some overlap with the CCI, but this study identified 2 novel predictors: cardiac arrhythmias and depression. Inclusion and reporting of these items within trauma registries would therefore be an important step to allow further validation and use of the MoRT.

Original languageEnglish (US)
Pages (from-to)370-375
Number of pages6
JournalAnnals of Surgery
Volume252
Issue number2
DOIs
StatePublished - Aug 1 2010
Externally publishedYes

Fingerprint

Comorbidity
Mortality
Wounds and Injuries
Aptitude
Hospital Mortality
Cardiac Arrhythmias
Depression
Social Adjustment
Cerebrovascular Disorders
Injury Severity Score
Dementia
Registries
Liver Diseases
Cohort Studies
Odds Ratio
Myocardial Infarction

ASJC Scopus subject areas

  • Surgery

Cite this

Thompson, H. J., Rivara, F. P., Nathens, A., Wang, J., Jurkovich, G., & MacKenzie, E. J. (2010). Development and validation of the mortality risk for trauma comorbidity index. Annals of Surgery, 252(2), 370-375. https://doi.org/10.1097/SLA.0b013e3181df03d6

Development and validation of the mortality risk for trauma comorbidity index. / Thompson, Hilaire J.; Rivara, Frederick P.; Nathens, Avery; Wang, Jin; Jurkovich, Gregory; MacKenzie, Ellen J.

In: Annals of Surgery, Vol. 252, No. 2, 01.08.2010, p. 370-375.

Research output: Contribution to journalArticle

Thompson, HJ, Rivara, FP, Nathens, A, Wang, J, Jurkovich, G & MacKenzie, EJ 2010, 'Development and validation of the mortality risk for trauma comorbidity index', Annals of Surgery, vol. 252, no. 2, pp. 370-375. https://doi.org/10.1097/SLA.0b013e3181df03d6
Thompson, Hilaire J. ; Rivara, Frederick P. ; Nathens, Avery ; Wang, Jin ; Jurkovich, Gregory ; MacKenzie, Ellen J. / Development and validation of the mortality risk for trauma comorbidity index. In: Annals of Surgery. 2010 ; Vol. 252, No. 2. pp. 370-375.
@article{77485bc64f5a4c3093526bbe39866e3a,
title = "Development and validation of the mortality risk for trauma comorbidity index",
abstract = "Objective: The aim of this study was to develop and validate a comorbidity index to predict the risk of mortality associated with chronic health conditions following a traumatic injury. Summary background data: Currently available comorbidity adjustment tools do not account for certain chronic conditions, which may influence outcome following traumatic injury or they have not been fully validated for trauma. Controlling for comorbidity in trauma patients is becoming increasingly important as the population ages and elderly patients are more active, as well as to adjust for bias in trauma mortality studies. Methods: Cohort study using data from the National Study on the Costs and Outcome of Trauma. Subject pool (N = 4644/Weighted Number = 14,069) was randomly divided in half; the first half of subjects was used to derive the risk scale, the second to validate the instrument. To construct the Mortality Risk Score for Trauma (MoRT), univariate analysis and odds ratios were performed to determine relative risk of mortality at hospital discharge comparing those persons with a comorbid condition to those without. Conditions significantly associated with mortality (P < 0.05) were included in the multivariate model. The variables in the final model were used to build the MoRT. The predictive ability of the MoRT and the Charlson Comorbidity Index (CCI) for discharge and 1-year mortality were estimated using the c-statistic in the validation sample. Results: Six comorbidity factors were independently associated with the risk of mortality and formed the basis for the MoRT: severe liver disease, myocardial infarction, cerebrovascular disease, cardiac arrhythmias, dementia, and depression. The MoRT had a similar overall discrimination as the CCI for mortality at hospital discharge in injured adults (c-statistic: 0.56 vs. 0.56) although neither by itself performed well. The addition of age and gender improved the predictive ability of the MoRT (0.59; 95{\%} CI: 0.56, 0.62) and the CCI (0.59; 0.56, 0.62). Similar results were seen at 1-year postinjury. The further addition of Injury Severity Score significantly improved the predictive ability of the MoRT (0.77, 95{\%} CI: 0.74, 0.79) and the CCI (0.77, 95{\%} CI: 0.75, 0.80). Conclusions: The MoRTs primary advantage over current instruments is its parsimony, containing only 6 items. In the present study, the comorbid conditions found to be predictive of mortality had some overlap with the CCI, but this study identified 2 novel predictors: cardiac arrhythmias and depression. Inclusion and reporting of these items within trauma registries would therefore be an important step to allow further validation and use of the MoRT.",
author = "Thompson, {Hilaire J.} and Rivara, {Frederick P.} and Avery Nathens and Jin Wang and Gregory Jurkovich and MacKenzie, {Ellen J.}",
year = "2010",
month = "8",
day = "1",
doi = "10.1097/SLA.0b013e3181df03d6",
language = "English (US)",
volume = "252",
pages = "370--375",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Development and validation of the mortality risk for trauma comorbidity index

AU - Thompson, Hilaire J.

AU - Rivara, Frederick P.

AU - Nathens, Avery

AU - Wang, Jin

AU - Jurkovich, Gregory

AU - MacKenzie, Ellen J.

PY - 2010/8/1

Y1 - 2010/8/1

N2 - Objective: The aim of this study was to develop and validate a comorbidity index to predict the risk of mortality associated with chronic health conditions following a traumatic injury. Summary background data: Currently available comorbidity adjustment tools do not account for certain chronic conditions, which may influence outcome following traumatic injury or they have not been fully validated for trauma. Controlling for comorbidity in trauma patients is becoming increasingly important as the population ages and elderly patients are more active, as well as to adjust for bias in trauma mortality studies. Methods: Cohort study using data from the National Study on the Costs and Outcome of Trauma. Subject pool (N = 4644/Weighted Number = 14,069) was randomly divided in half; the first half of subjects was used to derive the risk scale, the second to validate the instrument. To construct the Mortality Risk Score for Trauma (MoRT), univariate analysis and odds ratios were performed to determine relative risk of mortality at hospital discharge comparing those persons with a comorbid condition to those without. Conditions significantly associated with mortality (P < 0.05) were included in the multivariate model. The variables in the final model were used to build the MoRT. The predictive ability of the MoRT and the Charlson Comorbidity Index (CCI) for discharge and 1-year mortality were estimated using the c-statistic in the validation sample. Results: Six comorbidity factors were independently associated with the risk of mortality and formed the basis for the MoRT: severe liver disease, myocardial infarction, cerebrovascular disease, cardiac arrhythmias, dementia, and depression. The MoRT had a similar overall discrimination as the CCI for mortality at hospital discharge in injured adults (c-statistic: 0.56 vs. 0.56) although neither by itself performed well. The addition of age and gender improved the predictive ability of the MoRT (0.59; 95% CI: 0.56, 0.62) and the CCI (0.59; 0.56, 0.62). Similar results were seen at 1-year postinjury. The further addition of Injury Severity Score significantly improved the predictive ability of the MoRT (0.77, 95% CI: 0.74, 0.79) and the CCI (0.77, 95% CI: 0.75, 0.80). Conclusions: The MoRTs primary advantage over current instruments is its parsimony, containing only 6 items. In the present study, the comorbid conditions found to be predictive of mortality had some overlap with the CCI, but this study identified 2 novel predictors: cardiac arrhythmias and depression. Inclusion and reporting of these items within trauma registries would therefore be an important step to allow further validation and use of the MoRT.

AB - Objective: The aim of this study was to develop and validate a comorbidity index to predict the risk of mortality associated with chronic health conditions following a traumatic injury. Summary background data: Currently available comorbidity adjustment tools do not account for certain chronic conditions, which may influence outcome following traumatic injury or they have not been fully validated for trauma. Controlling for comorbidity in trauma patients is becoming increasingly important as the population ages and elderly patients are more active, as well as to adjust for bias in trauma mortality studies. Methods: Cohort study using data from the National Study on the Costs and Outcome of Trauma. Subject pool (N = 4644/Weighted Number = 14,069) was randomly divided in half; the first half of subjects was used to derive the risk scale, the second to validate the instrument. To construct the Mortality Risk Score for Trauma (MoRT), univariate analysis and odds ratios were performed to determine relative risk of mortality at hospital discharge comparing those persons with a comorbid condition to those without. Conditions significantly associated with mortality (P < 0.05) were included in the multivariate model. The variables in the final model were used to build the MoRT. The predictive ability of the MoRT and the Charlson Comorbidity Index (CCI) for discharge and 1-year mortality were estimated using the c-statistic in the validation sample. Results: Six comorbidity factors were independently associated with the risk of mortality and formed the basis for the MoRT: severe liver disease, myocardial infarction, cerebrovascular disease, cardiac arrhythmias, dementia, and depression. The MoRT had a similar overall discrimination as the CCI for mortality at hospital discharge in injured adults (c-statistic: 0.56 vs. 0.56) although neither by itself performed well. The addition of age and gender improved the predictive ability of the MoRT (0.59; 95% CI: 0.56, 0.62) and the CCI (0.59; 0.56, 0.62). Similar results were seen at 1-year postinjury. The further addition of Injury Severity Score significantly improved the predictive ability of the MoRT (0.77, 95% CI: 0.74, 0.79) and the CCI (0.77, 95% CI: 0.75, 0.80). Conclusions: The MoRTs primary advantage over current instruments is its parsimony, containing only 6 items. In the present study, the comorbid conditions found to be predictive of mortality had some overlap with the CCI, but this study identified 2 novel predictors: cardiac arrhythmias and depression. Inclusion and reporting of these items within trauma registries would therefore be an important step to allow further validation and use of the MoRT.

UR - http://www.scopus.com/inward/record.url?scp=77955171127&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955171127&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e3181df03d6

DO - 10.1097/SLA.0b013e3181df03d6

M3 - Article

C2 - 20622665

AN - SCOPUS:77955171127

VL - 252

SP - 370

EP - 375

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 2

ER -