Description

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.

 


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