Comorbidity-Polypharmacy Score: A Novel Adjunct in Post-Emergency Department Trauma Triage

Abstract

OBJECTIVE-Post-emergency department (ED) triage of older trauma patients continues to be challenging as morbidity and mortality for any given level of injury severity tend to increase with age. The Comorbidity-Polypharmacy Score (CPS) combines the number of pre-injury medications with the number of comorbidities to estimate the severity of co-morbid conditions. This retrospective study examines the relationship between CPS and triage accuracy for older (≥45 years) patients admitted for traumatic injury. METHODS-Patients≥ 45 years old presenting to level 1 trauma center from 2005 to 2008 were included. Basic data included patient demographics, injury severity score (ISS), morbidity/ mortality, and functional outcome measures. CPS was calculated by adding total numbers of comorbid conditions and pre-injury medications. Patients were divided into 3 triage groups: undertriage, appropriate triage, and over-triage. Under-triage criteria included initial admission to the floor or step-down unit followed by an unplanned transfer to ICU within 24 hours of admission. Over-triage was defined as initial ICU admission for <1 day without stated need for ICU level of care (i.e., lack of evidence for tracheal intubation/mechanical ventilation, injuryrelated hemorrhage, or other traditional ICU indications such as intracranial bleeding). All other patients were presumed to be correctly triaged. The three triage groups were then analyzed looking for contributors to mis-triage. RESULTS-Charts for 711 patients were evaluated (mean age 63.5, 55.7% male, mean ISS 9.02). Of those, 11 (1.55%) met criteria for "under-triage" and 14 (1.97%) were "over-triaged". The remaining 686 patients had no evidence of mis-triage. The three groups were similar in terms © 2012 Elsevier Inc. All rights reserved. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript of injury severity and age. The groups were significantly different with respect to CPS, with undertriage CPS scores (14.9±6.80) being nearly three times higher than the overtriage CPS scores (5.14±3.48). There were more similarities between appropriate and overtriage groups, with the undertriage group being characterized by greater number of complications, and lower functional outcomes at discharge (all, p<0.05). The undertriage group had significantly higher mortality (27%) than the appropriate and over-triage groups (6% and 0%, respectively).CONCLUSION-In the era of medication reconciliation, the CPS is easy to obtain and calculate in patients who are not...

Factors affecting mortality in older trauma patients—A systematic review and meta-analysis

“…A variety of factors affect outcome from major trauma in older people. These include demographic factors, such as age, gender and social status; injury characteristics (injury pattern and severity); pre-existing medical conditions and the patients' physiological state on admission to hospital (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Despite extensive research, there is no clear agreement on the relative impact of these diverse factors on mortality in older people with major trauma.…”

Impact of the Comorbidity Polypharmacy Score on Clinical Outcome in Patients with Hip Fracture undergoing surgery Using Real-World Data

“…The CPS was first reported in 2011 [1]. It assigns one point for each disease process or comorbidity and one point for each drug the patient is taking before admission; there is no maximum score [9][10][11]. The primary characteristic of CPS is that it encompasses all disease processes and evaluates their severity based on the number of medications.…”