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)



Low Risk

Moderate Risk

High Risk


16 to 49 years

50 to 74 years

>= 75 years


1 to 15

16 to 24

>= 25


0 or 1


>= 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



• 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.

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