Is the Charlson Comorbidity Index Useful for Predicting Trauma Outcomes?

Gabbe, Belinda; Magtengaard, Kirstine; Hannaford, Andrew; Cameron, Peter

doi:10.1111/j.1553-2712.2005.tb01950.x

Cited by 59 publications

(56 citation statements)

References 10 publications

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“…The association of the CCI with mortality after trauma is consistent with prior studies in which higher in-hospital mortality was found in patients with hip fractures with higher CCI scores [9,25].…”

Section: Discussionsupporting

confidence: 90%

“…With the economic penalties associated with readmission after surgery with the Hospital Readmissions Reduction Program [6,16,19], there now are financial and professional incentives to improve our ability to anticipate complications of treatment. The CCI has been used as a predictor for adverse events [2,9,17,30,[32][33][34]37]. Our study addressed the association of comorbidities as measured by the CCI on readmission and adverse outcomes after orthopaedic surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…In orthopaedic surgery, comorbidities have been identified as predictors of mortality after arthroplasty, trauma surgery, and oncologic surgery [4,9,18,20,21,25,27,36]. Complications after ankle fractures, spinal metastasis surgery, and knee or hip arthroplasty also are associated with comorbidities [2,12,[31][32][33][34] as are infections after orthopaedic trauma, spine surgery, knee or hip arthroplasty [8,17,22,36], and transfusion after knee or shoulder arthroplasty [12,29].…”

Section: Introductionmentioning

confidence: 99%

“…A higher CCI indicates a higher risk of death within 1 year. The CCI also has been evaluated as a predictor for outcomes after orthopaedic trauma surgery, postoperative adverse events after general surgery, and readmission for geriatric and general medicine patients [2,9,17,30,[32][33][34]37].…”

Section: Introductionmentioning

confidence: 99%

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Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Voskuijl

Hageman

Ring

2014

Clinical Orthopaedics &Amp; Related Research

172

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Background The Charlson Comorbidity Index (CCI) originally was developed to predict mortality within 1 year of hospital admission in patients without trauma. As it includes factors associated with medical and surgical complexities, it also may be useful as a predictive tool for hospital readmission after orthopaedic surgery, but to our knowledge, this has not been studied. Questions/purposes We asked whether an increased score on the CCI was associated with (1) readmission, (2) an increased risk of surgical site infection or other adverse events, (3) transfusion risk, or (4) mortality after orthopaedic surgery. Methods A total of 30,129 orthopaedic surgeries performed between 2008 and 2011 without any orthopaedic surgery in the preceding 30 days were analyzed. International Classification of Diseases, 9 th Revision codes were used to identify diagnoses, procedures, surgery-related adverse events, surgical site infection, and comorbidities as listed in the updated and reweighted CCI. A total of 913 patients (3.0%) were readmitted within 30 days after discharge; in 393 (1.4%) patients adverse events occurred; 417 patients (1.4%) had a surgical site infection develop; 211 (0.7%) needed transfusions, and 56 (0.2%) died within 30 days after surgery. Ordinary least squares regression analyses were used to determine whether the CCI was associated with these outcomes. Results The CCI accounted for 10% of the variation in readmissions. Every point increase in CCI score added an additional 0.45% risk in readmission for patients undergoing arthroplasty, 0.63% for patients undergoing trauma surgery, and 0.9% risk for patients undergoing spine surgery (all p \ 0.01). The CCI was not associated with surgical site infection or other adverse events, but accounted for 8% of the variation in transfusion rate and 10% of the variation in mortality within 30 days of surgery. Conclusions The CCI can be used to estimate the risk of readmission after arthroplasty, hand and upper extremity surgery, spine surgery, and trauma surgery. It also can be used to estimate the risk of transfusion after arthroplasty, spine, trauma, and oncologic orthopaedic surgery and the risk of mortality after shoulder, trauma, and oncologic orthopaedic surgery.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Voskuijl

Hageman

Ring

2014

Clinical Orthopaedics &Amp; Related Research

172

View full text Add to dashboard Cite

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“…10 Despite prolific use, the Charleson Comorbidity Index showed little or limited predictive power on trauma mortality. 18 The incremental risk of death with more comorbid diseases and polytrauma is mainly explained by allostatic load, a dose-dependent physiological stress resulting from chronic 'wear and tear' . 19 Studies that incorporated concomitant injuries on mortality prediction mostly relied on the Injury Severity Score (ISS) with demonstrable effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Determinants of in-hospital death after acute spinal cord injury: a population-based study

et al. 2012

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Objectives: First, to evaluate the influence of comorbid diseases and concomitant injuries on the risk of in-hospital death after traumatic spinal cord injury (TSCI). Second, to identify the risk characteristics of TSCI patients with likelihood of death. Study design: Population-based retrospective cohort study. Setting: Sixty-two acute care hospitals in South Carolina, USA. Methods: Records of 3389 TSCI patients hospitalized with acute TSCI were evaluated. Days elapsing from the date of injury to date of death established the survival time (T). Cox regression examined risk of in-hospital death as a function of counts of comorbid conditions and injuries along with their joint effects controlling for other covariates. Results: Counts of comorbid conditions and injuries showed dose-dependent risk of death while in-hospital independent of demographical and clinical covariates. Hazard ratios (HR) for counts 3 þ , 2 and 1 comorbid conditions were 2.19 (Po0.001), 1.73 (P ¼ 0.005) and 1.20 (P ¼ 0.322), respectively. For counts of 4 þ , 3 and 2 other injuries were 1.85 (Po0.001), 1.81 (Po0.001) and 1.46 (P ¼ 0.022), respectively. The joint effect of the two was transadditive with statistically significant HR ranging from 1.72-3.14. Conclusion: Counts of comorbid conditions and injured body regions strongly indicate risk of in-hospital death after TSCI and their joint effects elicited dose-dependent gradient independent of demographical and clinical covariates. Assessing risk of in-hospital death based on joint use of counts of comorbid diseases and injuries is highly informative to target TSCI patients at high risk of dying.

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Major trauma in older persons

et al. 2018

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BackgroundGlobally, populations are ageing, creating challenges for trauma system design. Despite this, little is known about causes of injury and long‐term outcomes in older injured patients. This study aims to describe temporal trends in the incidence, causes and functional outcomes of major trauma in older adults.MethodsThe population‐based Victorian State Trauma Registry was used to identify patients with major trauma aged 65 years and older with a date of injury between 1 January 2007 and 31 December 2016. Temporal trends in population‐based incidence rates were evaluated. Functional outcome was measured using the Glasgow Outcome Scale – Extended.ResultsThere were 9250 older adults with major trauma during the study period. Low falls were the most common mechanism of injury (62·5 per cent), followed by transport‐related events (22·2 per cent) and high falls (9·5 per cent). The number of patients with major trauma aged 65 years and older more than doubled from 2007 to 2016, and the incidence increased by 4·3 per cent per year (incidence rate ratio 1·043, 95 per cent c.i. 1·035 to 1·050; P < 0·001). At 12 months after injury, 41·8 per cent of older adults with major trauma had died, and 52·2 per cent of those who survived to hospital discharge were not living independently.ConclusionsThe number and proportion of older adults with major trauma are increasing rapidly and this will impact on trauma system design. Given the poor long‐term outcomes, there needs to be greater emphasis on ensuring that appropriate interventions are targeted to the right patients and enhanced efforts in primary prevention.

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Is the Charlson Comorbidity Index Useful for Predicting Trauma Outcomes?

Abstract: While the CCI can be extrapolated from ICD codes and provides a measure of comorbid condition severity and was associated with mortality, addition of the CCI to prediction models did not result in a substantial improvement in performance.

Cited by 59 publications

References 10 publications

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Determinants of in-hospital death after acute spinal cord injury: a population-based study

Major trauma in older persons

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