A patient with one or more pre-existing diseases (PED) often will have a worse prognosis for a matched patient without the comorbid condition(s). These patients may require more aggressive therapy to reduce morbidity and mortality. The authors are from Georgetown University and the Maryland Institute for Emergency Medical Services System (Shock Trauma Center).
|
Organ System |
Criteria for pre-existing disease (PED) |
|
cardiac disease |
documented history of myocardial infarction OR taking any cardiac medication OR history of cardiac surgery |
|
diabetes mellitus |
documented history of non-insulin or insulin dependent diabetes |
|
liver disease |
cirrhosis OR serum bilirubin > 2 mg/dL on admission |
|
malignancy |
documented history |
|
pulmonary |
documented history of asthma or COPD |
|
obesity |
female > 200 pounds OR male > 250 pounds |
|
renal disease |
serum creatinine > 2 mg/dL on admission |
|
neurologic disease |
documented history of stroke (cerebrovascular accident) |
|
hypertension |
any anti-hypertensive medication OR documented history |
where:
• The criteria need to take into account the impact of the trauma. For example, liver enzymes might be elevated from trauma and a hypertensive patient may be hypotensive.
• Body mass index (BMI) might be a suitable method to determine obesity.
number of pre-existing diseases =
= (number of criteria met)
|
number of PED |
mortality rate |
|
0 |
3.2% |
|
1 |
6.1% |
|
2 |
15.5% |
|
>= 3 |
24.9% |
from Table 3, page 239
After 45 years of age, patients with pre-existing diseases have 1-2% higher mortality rate than persons without a pre-existing disease. This is in addition to the increasing mortality rate starting after age 55.
|
age |
mortality rate if PED negative |
mortality rate if PED positive |
|
15 to 24 |
2.5% |
3.6% |
|
25 to 34 |
2.1% |
2.8% |
|
35 to 44 |
3.4% |
4% |
|
45 to 54 |
4.1% |
5.4% |
|
55 to 64 |
6% |
8.5% |
|
65 to 74 |
11.1% |
13.9% |
|
>= 75 |
27.9% |
30.1% |
after Figure 4, page 240
Patients with pre-existing diseases have consistently higher mortality for a given injury severity score (ISS) when compared to those without a pre-existing disease.
|
ISS |
mortality rate if PED negative |
mortality rate if PED positive |
|
1 to 8 |
0.1% |
0.5% |
|
9 to 12 |
0.4% |
5% |
|
13 to 15 |
0% |
2.5% |
|
16 to 20 |
1.8% |
9.9% |
|
> 20 |
10% |
23.3% |
after Figure 5, page 240
Limitations:
• Conditions like substance abuse and psychological disorders were not included for reasons described on page 242.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
ICD-10: ,
