Shoko et al identified risk factors for in-hospital mortality for a trauma patient in Japan, including pre-existing medical conditions. These can help to identify a patient who may benefit from more aggressive management. The authors are from Tokyo Medical and Dental University Hospital.
Patient selection: trauma, age >= 16 years
Outcome: in-hospital mortality
Risk factors for in-hospital mortality:
(1) increasing age
(2) increasing injury severity score (ISS)
(3) increasing pre-existing medical conditions (PEMC)
|
Parameter
|
Low Risk
|
Moderate Risk
|
High Risk
|
|
age
|
16 to 49 years
|
50 to 74 years
|
>= 75 years
|
|
ISS
|
1 to 15
|
16 to 24
|
>= 25
|
|
PEMC
|
0 or 1
|
NA
|
>= 2
|
Pre-existing conditions contributing to risk:
(1) dementia or mental retardation
(2) COPD
(3) cirrhosis
(4) active cancer
(5) hematologic disorder
(6) anticoagulation therapy
(7) "other medical conditions" (odds ratio 1.3)
Pre-existing conditions associated with reduced risk:
(1) psychotic disorder
(2) bronchial asthma
where:
• The pre-existing conditions are those noted by the authors.
• Table 2 indicates that congestive heart failure and hepatitis may negatively affect outcome while peptic ulcer, inflammatory bowel disease, obesity and immunosuppression may reduce risk.
