Road Crashes in Older Persons and the Use of Comorbidity Polypharmacy Score in an Asian Population

Abstract

Introduction: Age-related physiological changes predispose older road users to higher mortality from traffic crashes. We aimed to describe the injury epidemiology of these patients, and explore the association between the comorbidity polypharmacy score (CPS) and outcomes. Materials and Methods: This retrospective study utilised data from the Trauma Registry in the National University Hospital, Singapore, between January 2011 and December 2014. Patients involved in traffic crashes aged 45 years and above with injury severity scores (ISS) of 9 and higher were included. Results: There were 432 patients; median age was 58 (interquartile range, 51 to 65.5) years with predominance of male patients (82.2%) and Chinese ethnicity (66%). Overall mortality was 9.95%, with lower odds associated with higher Glasgow Coma Scale (odds ratio [OR] 0.73; 95% confidence interval [CI], 0.65 to 0.81, P <0.001), higher diastolic blood pressure (OR 0.98; 95% CI, 0.97 to 1.00, P = 0.031), and lower ISS of 9 to 15 (OR 0.10; 95% CI, 0.02 to 0.43, P = 0.002). The need for blood products was associated with higher mortality (OR 7.62; 95% CI, 2.67 to 21.7, P <0.001). CPS did not predict mortality. Independent predictors of discharge venue included length of stay, tier of injury and CPS group. Moderate CPS was statistically significant for nursing home placement (OR 10.7; 95% CI, 2.33 to 49.6, P = 0.002) but not for rehabilitation facility. Conclusion: CPS score is useful in predicting discharge to a nursing home facility for older patients with traffic crashes. Further larger studies involving other trauma types in the Asian population are needed to evaluate its utility. Key words: Elderly, Motor vehicle crashes, Trauma severity indices

The Changing Epidemiology of Serious Trauma in the Elderly Population: An Increasing Concern of a Tertiary Hospital in Singapore

“…Some studies have suggested age as an independent factor that can be used to predict outcomes. [19][20][21] Similar to findings in other studies, elderly patients in our study had more comorbidities than young patients. 22,23 The increase in comorbidities in young and elderly patients between 2004 and 2015 might be attributed to the promotion of health screening by the authorities and cheaper screening tests that were made widely available to residents in Singapore.…”

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.…”