Morris et al identified pre-existing conditions (PEC) which may impact mortality in trauma patients. These should be considered when triaging a trauma patient since they may change a moderate injury to one that is life-threatening. The authors are from Vanderbilt University in Nashville.


Comorbid conditions with major increase in mortality:

(1) cirrhosis (relative odds 4.5)

(2) hereditary coagulation disorder (relative odds 3.2)


Comorbid conditions with some increase in mortality (relative odds 1.2 to 1.8):

(3) ischemic heart disease

(4) chronic obstructive pulmonary disease (COPD)

(5) diabetes mellitus


Situations where impact of PEC is greatest:

(1) adult 25 - 64 years of age (maximal from 45-54) with injury of any severity

(2) injuries of mild to moderate severity (ISS < 13)



• In the implementation I assigned 3 points to cirrhosis, 2 to coagulopathy and 1 for the remaining 3 PEC.

• In the implementation have also experimented with a "PEC score" based on combining the SUM of the points assigned to the pre-existing conditions (maximal score 8) plus the number of situations with increased PEC impact (maximal 2). This would apply if there was 1 or more PEC).


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