Association Between Charlson Comorbidity Index Items and Outcomes in Patients With Blunt Trauma Using a Nationwide...

Understanding a patient's medical history and comorbidities before arrival at a hospital can help select the appropriate medical institution for transport and may be related to outcomes by assisting with treatment after arrival at the hospital. This study aimed to clarify the comorbidities associated with blunt trauma outcomes.

Using the Japan Trauma Data Bank (JTDB), a nationwide large dataset in Japan, we studied 119,929 cases of blunt trauma among patients admitted to JTDB-participating hospitals from January 2019 to December 2022, excluding those with cardiac arrest before hospital arrival. We compared the groups according to the severity of the trauma, age, sex, and each item of the original Charlson Comorbidity Index (CCI) at the time of discharge and then used Cox regression analysis, a multivariate analysis, to explore the relationship between the outcome and each item of the CCI.

There were significant differences in 10 of the 19 CCI items between the mortality and survival groups. However, Cox regression analysis, including the bootstrap method, was narrowed down to seven items, and the comorbidities that were significantly associated with mortality were leukemia, moderate or severe liver disease, metastatic malignant neoplasm, moderate renal disease, congestive heart failure, collagen disease, and chronic pulmonary disease in that order.

Comorbidities that can affect the prognosis of blunt trauma were identified from the items in the original CCI. It is beneficial for emergency medical personnel to know about pre-existing comorbidities associated with the prognosis of blunt trauma cases when selecting a transport facility before arrival at the hospital, and the condition of trauma cases with pre-existing or dysfunctional major organs, such as the liver, kidneys, heart, and lungs, should not be underestimated.