Comorbidity-polypharmacy scoring may improve outcome prediction in older trauma patients

Evans, David C.; Cook, Charles H.; Christy, Jonathan M.; Murphy, Claire V.; Gerlach, Anthony T.; Lindsey, David E.; Whitmill, Melissa L.; Beery, Paul R.; Steinberg, Steven M.; Stawicki, Stanislaw P.

doi:10.1016/j.jamcollsurg.2010.06.152

Cited by 6 publications

(9 citation statements)

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“…In order to provide an easy-to-use method of quantification of the overall impact of co-morbid conditions (including their overall severity) on clinical outcomes, our group introduced the Comorbidity-Polypharmacy Score (CPS) – a sum of all known comorbid preinjury conditions and medications present for any given patient (10, 11). Higher CPS has been associated with more severe clinical course in older trauma patients (i.e., longer hospital stays, greater mortality, and prolonged recovery) despite lower overall injury severity (10, 11).…”

Section: Introductionmentioning

confidence: 99%

“…Higher CPS has been associated with more severe clinical course in older trauma patients (i.e., longer hospital stays, greater mortality, and prolonged recovery) despite lower overall injury severity (10, 11). Based on these preliminary findings, we examined whether CPS might also be useful as an objective triage tool for older trauma patients.…”

Section: Introductionmentioning

confidence: 99%

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Comorbidity-polypharmacy score: A novel adjunct in post–emergency department trauma triage

Justiniano

Evans

Cook

et al. 2013

Journal of Surgical Research

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OBJECTIVE Post-emergency department (ED) triage of older trauma patients continues to be challenging as morbidity and mortality for any given level of injury severity tend to increase with age. The Comorbidity-Polypharmacy Score (CPS) combines the number of pre-injury medications with the number of comorbidities to estimate the severity of co-morbid conditions. This retrospective study examines the relationship between CPS and triage accuracy for older (≥45 years) patients admitted for traumatic injury. METHODS Patients ≥ 45 years old presenting to level 1 trauma center from 2005 to 2008 were included. Basic data included patient demographics, injury severity score (ISS), morbidity/mortality, and functional outcome measures. CPS was calculated by adding total numbers of co-morbid conditions and pre-injury medications. Patients were divided into 3 triage groups: undertriage, appropriate triage, and over-triage. Under-triage criteria included initial admission to the floor or step-down unit followed by an unplanned transfer to ICU within 24 hours of admission. Over-triage was defined as initial ICU admission for <1 day without stated need for ICU level of care (i.e., lack of evidence for tracheal intubation/mechanical ventilation, injury-related hemorrhage, or other traditional ICU indications such as intracranial bleeding). All other patients were presumed to be correctly triaged. The three triage groups were then analyzed looking for contributors to mis-triage. RESULTS Charts for 711 patients were evaluated (mean age 63.5, 55.7% male, mean ISS 9.02). Of those, 11 (1.55%) met criteria for “under-triage” and 14 (1.97%) were “over-triaged”. The remaining 686 patients had no evidence of mis-triage. The three groups were similar in terms of injury severity and age. The groups were significantly different with respect to CPS, with undertriage CPS scores (14.9±6.80) being nearly three times higher than the overtriage CPS scores (5.14±3.48). There were more similarities between appropriate and overtriage groups, with the undertriage group being characterized by greater number of complications, and lower functional outcomes at discharge (all, p<0.05). The undertriage group had significantly higher mortality (27%) than the appropriate and over-triage groups (6% and 0%, respectively). CONCLUSION In the era of medication reconciliation, the CPS is easy to obtain and calculate in patients who are not critically injured. This study suggests that CPS may be a promising adjunct in identifying older trauma patients who are more likely to be under-triaged. The significance of our findings is especially important when considering that injury severity in the undertiage group was similar to injury severity in the other groups. Further evaluation of CPS as a triage tool in acute trauma is warranted.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comorbidity-polypharmacy score: A novel adjunct in post–emergency department trauma triage

Justiniano

Evans

Cook

et al. 2013

Journal of Surgical Research

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“…The CPS (Comorbidity-Polypharmacy Score) was defined as the total number of pre-injury medications plus comorbidities for each patient (10,11). Functional outcome measures were divided into the following three categories, scored (1-to-4) low-to-high: (a) expressioncommunication; (b) locomotion; and (c) self-feeding (11).…”

Section: Methodsmentioning

confidence: 99%

“…In order to provide an easy-to-use method of quantification of the overall impact of comorbid conditions (including their overall severity) on clinical outcomes, our group introduced the Comorbidity-Polypharmacy Score (CPS) -a sum of all known comorbid preinjury conditions and medications present for any given patient (10,11). Higher CPS has been associated with more severe clinical course in older trauma patients (i.e., longer hospital stays, greater mortality, and prolonged recovery) despite lower overall injury severity (10,11).…”

Section: Introductionmentioning

confidence: 99%

“…Higher CPS has been associated with more severe clinical course in older trauma patients (i.e., longer hospital stays, greater mortality, and prolonged recovery) despite lower overall injury severity (10,11). Based on these preliminary findings, we examined whether CPS might also be useful as an objective triage tool for older trauma patients.…”

Section: Introductionmentioning

confidence: 99%

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Comorbidity-Polypharmacy Score: A Novel Adjunct in Post-Emergency Department Trauma Triage

Justiniano¹,

Evans²,

Beery³

et al. 2012

Journal of Surgical Research

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OBJECTIVE-Post-emergency department (ED) triage of older trauma patients continues to be challenging as morbidity and mortality for any given level of injury severity tend to increase with age. The Comorbidity-Polypharmacy Score (CPS) combines the number of pre-injury medications with the number of comorbidities to estimate the severity of co-morbid conditions. This retrospective study examines the relationship between CPS and triage accuracy for older (≥45 years) patients admitted for traumatic injury. METHODS-Patients≥ 45 years old presenting to level 1 trauma center from 2005 to 2008 were included. Basic data included patient demographics, injury severity score (ISS), morbidity/ mortality, and functional outcome measures. CPS was calculated by adding total numbers of comorbid conditions and pre-injury medications. Patients were divided into 3 triage groups: undertriage, appropriate triage, and over-triage. Under-triage criteria included initial admission to the floor or step-down unit followed by an unplanned transfer to ICU within 24 hours of admission. Over-triage was defined as initial ICU admission for <1 day without stated need for ICU level of care (i.e., lack of evidence for tracheal intubation/mechanical ventilation, injuryrelated hemorrhage, or other traditional ICU indications such as intracranial bleeding). All other patients were presumed to be correctly triaged. The three triage groups were then analyzed looking for contributors to mis-triage. RESULTS-Charts for 711 patients were evaluated (mean age 63.5, 55.7% male, mean ISS 9.02). Of those, 11 (1.55%) met criteria for "under-triage" and 14 (1.97%) were "over-triaged". The remaining 686 patients had no evidence of mis-triage. The three groups were similar in terms © 2012 Elsevier Inc. All rights reserved. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript of injury severity and age. The groups were significantly different with respect to CPS, with undertriage CPS scores (14.9±6.80) being nearly three times higher than the overtriage CPS scores (5.14±3.48). There were more similarities between appropriate and overtriage groups, with the undertriage group being characterized by greater number of complications, and lower functional outcomes at discharge (all, p<0.05). The undertriage group had significantly higher mortality (27%) than the appropriate and over-triage groups (6% and 0%, respectively).CONCLUSION-In the era of medication reconciliation, the CPS is easy to obtain and calculate in patients who are not...

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Physical activity but not sedentary activity is reduced in primary Sjögren’s syndrome

Miller

Bowman

et al. 2016

Rheumatol Int

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The aim of the study was to evaluate the levels of physical activity in individuals with primary Sjögren’s syndrome (PSS) and its relationship to the clinical features of PSS. To this cross-sectional study, self-reported levels of physical activity from 273 PSS patients were measured using the International Physical Activity Questionnaire-short form (IPAQ-SF) and were compared with healthy controls matched for age, sex and body mass index. Fatigue and other clinical aspects of PSS including disease status, dryness, daytime sleepiness, dysautonomia, anxiety and depression were assessed using validated tools. Individuals with PSS had significantly reduced levels of physical activity [median (interquartile range, IQR) 1572 (594–3158) versus 3708 (1732–8255) metabolic equivalent of task (MET) × min/week, p < 0.001], but similar levels of sedentary activity [median (IQR) min 300 (135–375) versus 343 (223–433) (MET) × min/week, p = 0.532] compared to healthy individuals. Differences in physical activity between PSS and controls increased at moderate [median (IQR) 0 (0–480) versus 1560 (570–3900) MET × min/week, p < 0.001] and vigorous intensities [median (IQR) 0 (0–480) versus 480 (0–1920) MET × min/week, p < 0.001]. Correlation analysis revealed a significant association between physical activity and fatigue, orthostatic intolerance, depressive symptoms and quality of life. Sedentary activity did not correlate with fatigue. Stepwise linear regression analysis identified symptoms of depression and daytime sleepiness as independent predictors of levels of physical activity. Physical activity is reduced in people with PSS and is associated with symptoms of depression and daytime sleepiness. Sedentary activity is not increased in PSS. Clinical care teams should explore the clinical utility of targeting low levels of physical activity in PSS.Electronic supplementary materialThe online version of this article (doi:10.1007/s00296-016-3637-6) contains supplementary material, which is available to authorized users.

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Comorbidity-polypharmacy scoring may improve outcome prediction in older trauma patients

Cited by 6 publications

References 0 publications

Comorbidity-polypharmacy score: A novel adjunct in post–emergency department trauma triage

Comorbidity-polypharmacy score: A novel adjunct in post–emergency department trauma triage

Comorbidity-Polypharmacy Score: A Novel Adjunct in Post-Emergency Department Trauma Triage

Physical activity but not sedentary activity is reduced in primary Sjögren’s syndrome

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