McGwin et al evaluated the effect of comorbid conditions on mortality in older trauma patients. This can help identify patients who may require closer monitoring and more aggressive management. The authors are from the University of Alabama and the Medical Examiner Office in Birmingham, Alabama.


The risk of mortality was increased in patients > 50 years of age when compared to a healthy person of the same age if:

(1) 1 or more pre-existing comorbid conditions was/were present and

(2) the trauma was minor (Injury Severity Score < 16).


The mortality rate in an older adult with comorbid conditions was not increased compared to that of a healthy person of the same age after moderate or severe trauma.


Trauma Severity

< 16


16 - 25


> 25



Comorbid (chronic medical) conditions included:

(1) chronic alcohol and/or drug abuse

(2) hereditary or acquired coagulopathy

(3) gastric or esophageal varices

(4) peptic ulcer disease

(5) anemia

(6) chronic steroid therapy or immunosuppression

(7) malignancy with metastases

(8) malignancy with active chemotherapy

(9) transplantation

(10) diabetes mellitus (non-insulin dependent and insulin dependent)

(11) congestive heart disease

(12) cor pulmonale

(13) coronary artery disease

(14) history of major cardiac surgery

(15) history of myocardial infarction

(16) coumadin therapy

(17) inflammatory bowel disease

(18) rheumatoid arthritis (RA)

(19) systemic lupus erythematosus (SLE)

(20) history of cirrhosis

(21) history of pancreatitis

(22) total serum bilirubin > 2 mg/dL on admission

(23) Alzheimer's disease or chronic dementia

(24) cerebrovascular disease or stroke with residual

(25) chronic demyelinating disease

(26) history of major psychiatric disorders

(27) multiple sclerosis

(28) organic brain syndrome

(29) Parkinson's disease

(30) seizure disorder

(31) asthma

(32) chronic obstructive pulmonary disease (COPD)

(33) other chronic lung disease with ongoing treatment



• Chronic renal insufficiency is not listed.

• Chronic endocrine disorders other than diabetes are not listed.


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