Trauma Activation Touchpoints as an Opportunity to Detect Undiagnosed Comorbidities in Vulnerable Populations

Many trauma patients have undiagnosed comorbidities. We hypothesized that among nonprivately insured patients, those with undiagnosed comorbidities have quantifiable metrics at the time of trauma activation (TA) associated with such diagnoses.

1) To identify quantifiable metrics at TA that indicate the presence of undiagnosed comorbidities. 2) To evaluate the relationship between early clinical indicators at TA and the likelihood of receiving a new diagnosis within one year.

We reviewed the first 250 patients at our level 1 trauma center in 2021 and collected blood pressures, glucose levels, other laborator tests, primary care physician (PCP) appointments, and diagnoses in the year after TA. National guidelines were used to define hypertension and hyperglycemia. Associations between patient characteristics and new diagnoses in the year after TA were identified. Secondary outcomes included new diagnoses of substance use disorder, Human Immunodeficiency Virus (HIV), and hepatitis C within 1 year of TA.

In this cohort of 250 patients, 75.0% were male and median age of 44 (29-68) years. Of the 178 patients without prior diagnosis of hypertension, 84 (47.2%) exhibited hospitalized blood pressures meeting stage 1 hypertension criteria and 45 (25.3%) exhibited hospitalized blood pressures meeting stage 2 hypertension criteria. Of the 220 patients without prior diagnosis of diabetes, 18 (8.2%) exhibited hospitalized glucose levels consistent with hyperglycemia. PCP follow-up after TA and hospitalized blood pressure meeting stage 2 hypertension criteria were independently associated with a new hypertension diagnosis. PCP follow-up after TA and hospitalized hyperglycemia were independently associated with a new diabetes diagnosis. Secondary outcomes included 19 new diagnoses of substance use disorder, 1 new HIV diagnosis, and 7 new hepatitis C diagnoses.

Trauma and emergency providers can identify potential comorbid conditions and proactively integrate patients' trauma care into longitudinal healthcare.