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. 2021 Oct;28(10):1150-1159.
doi: 10.1111/acem.14270. Epub 2021 Jun 8.

Comparison of a trauma comorbidity index with other measures of comorbidities to estimate risk of trauma mortality

Peter C Jenkins  1 , Brian E Dixon  2   3 , Stephanie A Savage  4 , Aaron E Carroll  2   5 , Craig D Newgard  6 , Christopher J Tignanelli  7   8   9 , Mark R Hemmila  10 , Lava Timsina  1
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Comparison of a trauma comorbidity index with other measures of comorbidities to estimate risk of trauma mortality

Peter C Jenkins et al. Acad Emerg Med. 2021 Oct.

Abstract

Background: Comorbidities influence the outcomes of injured patients, yet a lack of consensus exists regarding how to quantify that association. This study details the development and internal validation of a trauma comorbidity index (TCI) designed for use with trauma registry data and compares its performance to other existing measures to estimate the association between comorbidities and mortality.

Methods: Indiana state trauma registry data (2013-2015) were used to compare the TCI with the Charlson and Elixhauser comorbidity indices, a count of comorbidities, and comorbidities as separate variables. The TCI approach utilized a randomly selected training cohort and was internally validated in a distinct testing cohort. The C-statistic of the adjusted models was tested using each comorbidity measure in the testing cohort to assess model discrimination. C-statistics were compared using a Wald test, and stratified analyses were performed based on predicted risk of mortality. Multiple imputation was used to address missing data.

Results: The study included 84,903 patients (50% each in training and testing cohorts). The Indiana TCI model demonstrated no significant difference between testing and training cohorts (p = 0.33). It produced a C-statistic of 0.924 in the testing cohort, which was significantly greater than that of models using the other indices (p < 0.05). The C-statistics of models using the Indiana TCI and the inclusion of comorbidities as separate variables-the method used by the American College of Surgeons Trauma Quality Improvement Program-were comparable (p = 0.11) but use of the TCI approach reduced the number of comorbidity-related variables in the mortality model from 19 to one.

Conclusions: When examining trauma mortality, the TCI approach using Indiana state trauma registry data demonstrated superior model discrimination and/or parsimony compared to other measures of comorbidities.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors have no potential conflicts to disclose.

Figures

FIGURE 1
FIGURE 1
Comparison of observed and expected mortality using different comorbidity indices with corresponding comorbidity index scores. Expected mortality is stratified by decile of risk-adjusted, predicted mortality - - - - = Comorbidity index score, mean calculated per decile of expected mortality. CCI, Charlson Comorbidity Index; ECI, Elixhauser Comorbidity Index; TCI, trauma comorbidity index
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