Development and validation of the mortality risk for trauma comorbidity index.
Development and validation of the mortality risk for trauma comorbidity index.
复制标题
创伤合并症死亡风险指数的制定和验证。
DOI：
10.1097/sla.0b013e3181df03d6
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发表时间：
2010
影响因子：
9
通讯作者：
Mackenzie,EllenJ
中科院分区：
文献类型：
--
作者：
Thompson,HilaireJ;Rivara,FrederickP;Nathens,Avery;Wang,Jin;Jurkovich,GregoryJ;Mackenzie,EllenJ
目的：本研究的目的是开发和验证一个共病指数来预测创伤后慢性健康状况相关的死亡风险。摘要背景数据：目前可用的共病调整工具不能考虑某些可能影响创伤后预后的慢性疾病，或者它们没有被完全验证为创伤。随着人口老龄化和老年患者更加活跃，控制创伤患者的共病变得越来越重要，并对创伤死亡率研究中的偏差进行调整。方法：采用国家创伤成本和结果研究的数据进行队列研究。受试者池(N=4644/加权数=14,069)被随机分成两半；前一半受试者用于得出风险量表，第二半受试者用于验证工具。为了构建创伤死亡风险评分(MORT)，通过单变量分析和优势比来确定出院时死亡的相对风险，比较合并疾病者和非合并疾病者。在多变量模型中包括了与死亡率显著相关的疾病(P<；0.05)。最终模型中的变量被用来建立Mort。结果：严重肝病、心肌梗死、脑血管疾病、心律失常、痴呆症、抑郁症等6个共病因素与死亡风险独立相关，构成死亡风险的基础。MORT对于受伤成人出院时的死亡率与CCI有类似的总体区分(c-统计：0.56比0.56)，尽管两者本身都没有很好的表现。年龄和性别的增加提高了MORT(0.59；95%CI：0.56，0.62)和CCI(0.59；0.56，0.62)的预测能力。在受伤后1年也看到了类似的结果。进一步增加创伤严重程度评分可显著提高MORT(0.77，95%CI：0.74，0.79)和CCI(0.77，95%CI：0.75，0.80)的预测能力。
Objective:The aim of this study was to develop and validate a comorbidity index to predict the risk of mortality associated with chronic health conditions following a traumatic injury.Summary Background Data:Currently available comorbidity adjustment tools do not account for certain chronic conditions, which may influence outcome following traumatic injury or they have not been fully validated for trauma. Controlling for comorbidity in trauma patients is becoming increasingly important as the population ages and elderly patients are more active, as well as to adjust for bias in trauma mortality studies.Methods:Cohort study using data from the National Study on the Costs and Outcome of Trauma. Subject pool (N= 4644/Weighted Number= 14,069) was randomly divided in half; the first half of subjects was used to derive the risk scale, the second to validate the instrument. To construct the Mortality Risk Score for Trauma (MoRT), univariate analysis and odds ratios were performed to determine relative risk of mortality at hospital discharge comparing those persons with a comorbid condition to those without. Conditions significantly associated with mortality (P< 0.05) were included in the multivariate model. The variables in the final model were used to build the MoRT. The predictive ability of the MoRT and the Charlson Comorbidity Index (CCI) for discharge and 1-year mortality were estimated using the c-statistic in the validation sample.Results:Six comorbidity factors were independently associated with the risk of mortality and formed the basis for the MoRT: severe liver disease, myocardial infarction, cerebrovascular disease, cardiac arrhythmias, dementia, and depression. The MoRT had a similar overall discrimination as the CCI for mortality at hospital discharge in injured adults (c-statistic: 0.56 vs. 0.56) although neither by itself performed well. The addition of age and gender improved the predictive ability of the MoRT (0.59; 95% CI: 0.56, 0.62) and the CCI (0.59; 0.56, 0.62). Similar results were seen at 1-year postinjury. The further addition of Injury Severity Score significantly improved the predictive ability of the MoRT (0.77, 95% CI: 0.74, 0.79) and the CCI (0.77, 95% CI: 0.75, 0.80).Conclusions: