Comorbidities in Trauma Injury Severity Scoring System: Refining Current Trauma Scoring System

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Public Health

Background:

• Current trauma scoring systems like the Injury Severity Score (ISS) predict mortality but do not account for patient comorbidities.
• Comorbidities can influence patient outcomes and physiological reserve, potentially affecting trauma mortality and length of stay.

Purpose of the Study:

• To evaluate the impact of comorbidities on mortality and intensive care unit (ICU) length of stay in trauma patients.
• To determine if comorbidities are an independent predictor of outcomes when controlling for injury severity.

Main Methods:

• Retrospective review of 9845 adult trauma patients admitted between 2014 and 2016.
• Patients stratified by Injury Severity Score (ISS ≤ 15 and ISS > 15) and number of comorbidities (1-2 vs. ≥3).
• Statistical analysis using ANOVA, chi-squared, and t-tests (P < 0.05 significance).

Main Results:

• In the ISS ≤ 15 group, higher comorbidity counts (≥3) were linked to significantly increased mortality (1.50% vs. 0.12%, P ≪ 0.000007).
• Patients with ISS ≤ 15 and ≥3 comorbidities had higher mortality than those with ISS > 15 and 1-2 comorbidities (23.40% vs. 4.50%, P ≪ 0.000002).
• ICU length of stay was longer for ISS ≤ 15 patients with more comorbidities (17 vs. 10 days, P < 0.05).

Conclusions:

• Increased comorbidities are associated with significantly higher mortality in trauma patients, irrespective of injury severity.
• Comorbidities may indicate lower physiological reserve and act as an independent variable in trauma outcome prediction.
• Integrating comorbidity data into trauma scoring systems can enhance the accuracy and reliability of outcome predictions.