Highlights
- •Our study is the largest multi-ethnic Asian cohort evaluating the CPS in predicting trauma outcomes in the older population.
- •CPS is an independent predictor of mortality. Patients in the severe CPS category has 1.88-fold higher odds of death compared to those in the minor CPS category.
- •All CPS categories (moderate to morbid), when compared to the minor CPS group, are associated with increased odds for requiring rehabilitation or discharge to a long-term care facility after trauma.
- •CPS may be used as an adjunct to trauma severity scores to prognosticate and identify patients at higher risk of adverse outcomes.
Abstract
Background
An ageing population has caused rising trauma cases amongst older patients. Multiple
comorbidities, polypharmacy and limited reserves predispose them to poorer outcomes
following a traumatic event. The Comorbidity Polypharmacy Score (CPS) has been found
to predict outcomes and mortality in older trauma patients, but has not been studied
in Asians.
Aim
We aim to describe the epidemiological characteristics of older trauma patients and
explore the association of CPS on clinical outcomes.
Methods
We conducted a retrospective observational study using data from the trauma registries
of 2 tertiary trauma centres. Patients aged 45 years and above attending the emergency
departments (EDs) from January 2011 to December 2015 with traumatic injuries (Injury
Severity Score [ISS] of 9 and above) were included. Demographics, clinical data including
number of comorbidities and medications used were collected to calculate the CPS.
Outcomes of mortality, ED disposition and hospital discharge venue were examined.
Results
There were 4,522 patients (median age 70 years; males 53.8%), with majority sustaining
Tier 2 injuries (ISS 9 to 15; 68.9%). Falls were the predominant mechanism for those
aged above 60 years and above (76%). Median CPS was 6 (interquartile range [IQR] 1
to 11). Amongst patients 75 years and older, 56% comprised the moderate to morbid
CPS groups (CPS ≥ 8). Overall mortality was 8.4%; patients above 75 years had longer
median length of stay (10 versus 7.1–8.9 days in other ages). Male gender (adjusted
odds ratio [aOR] 1.51; 95% confidence interval [CI] 1.12–2.02), increasing age (aOR
1.04; 95% CI 1.03–1.05), injury to abdomen (aOR 3.24; 95% CI 1.93–5.45) and severe
CPS category (aOR 1.88; 95% CI 1.23–2.89) were associated with increased odds of death.
Increasing age and moderate CPS category increased odds of discharge to a rehabilitation
(aOR for age 1.03, 95% CI 1.02–1.04; aOR for moderate CPS 1.72, 95% CI 1.43–2.07)
or long-term care facility (aOR for age 1.05, 95% CI 1.03–1.06; aOR for CPS 1.60,
95% CI 1.10–2.32).
Conclusion
CPS predicted mortality and discharge to a rehabilitation or care facility in this
urban, ageing Asian population. Its use may aid future trauma research and needs assessments
in such patients.
Keywords
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Article info
Publication history
Published online: August 08, 2022
Accepted:
August 7,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
