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Epidemiology and outcomes of older trauma patients in Singapore: A multicentre study

      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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