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Development of a new comorbidity index for adults with cerebral palsy and comparative assessment with common

Daniel G Whitney1,2, Neil S Kamdar2,3,4,5

  • 1Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.

Developmental Medicine and Child Neurology
|December 8, 2020
PubMed

Insights

A new Whitney Comorbidity Index (WCI) for adults with cerebral palsy (CP) better predicts mortality than existing measures. The WCI includes relevant comorbidities for improved accuracy in CP patient outcomes.

Area of Science:

  • Medical research
  • Public health
  • Clinical informatics

Background:

  • Existing comorbidity indices like the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) do not adequately capture relevant comorbidities for adults with cerebral palsy (CP).
  • Accurate comorbidity assessment is crucial for predicting mortality and managing healthcare for individuals with CP.

Purpose of the Study:

  • To develop and validate a new comorbidity index, the Whitney Comorbidity Index (WCI), specifically for adults with cerebral palsy (CP).
  • To assess if the WCI demonstrates superior performance in predicting mortality compared to the CCI and ECI in this population.

Main Methods:

  • A retrospective cohort study utilized data from the Optum Clinformatics Data Mart, including 3022 adults with CP (1511 females, 1511 males).
  • Diagnosis codes identified comorbidities. The WCI was developed using Cox regression and competing risk analysis, incorporating comorbidities from CCI and ECI plus additional relevant ones.
  • Model fit and discrimination (C-statistic) were evaluated for unweighted (WCIunw) and weighted (WCIw) versions of the WCI, CCI, and ECI.

Main Results:

  • The WCI incorporated 27 comorbidities, including seven new ones not present in the CCI or ECI.
  • Both WCIunw and WCIw demonstrated superior model fit and discrimination for 1- and 2-year mortality compared to CCI and ECI.
  • The WCI indices were strong predictors of mortality, with C-statistics ranging from 0.81 to 0.88.

Conclusions:

  • The Whitney Comorbidity Index (WCI) is a novel and effective tool for assessing comorbidity burden in adults with cerebral palsy.
  • The WCI offers improved prediction of mortality for adults with CP, outperforming established indices like CCI and ECI.
  • This index, developed through a combination of clinical insight and data analysis, can aid in better patient management and outcome prediction for the CP population.
Abstract

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