• Richard Y Calvo, C Beth Sise, Michael J Sise, and Vishal Bansal.
• Scripps Mercy Hospital, Trauma Services, 4077 Fifth Avenue, San Diego, CA 92103, USA; SDSU/UCSD Joint Doctoral Program in Public Health (Epidemiology), 5500 Campanile Drive, San Diego, CA, 92182, USA. Electronic address: calvo.richard@scrippshealth.org.
• Am J Emerg Med. 2019 Oct 1; 37 (10): 1836-1845.

IntroductionPre-existing medical conditions (PEC) represent a unique domain of risk among older trauma patients. The study objective was to develop a metric to quantify PEC burden for trauma patients.MethodsA cohort of 4526 non-severe blunt-injured trauma patients aged 55 years and older admitted to a Level I trauma center between January 2006 and December 2012 were divided into development (80%) and test (20%) sets. Cox regression was used to develop the model based on in-hospital and 90-day mortality. Regression coefficients were converted into a point-based PEC Risk Score. Performance of the PEC Risk Score was compared in the test set with two other PEC-based metrics and three injury-based metrics. An external cohort of 2284 trauma patients admitted in 2013 was used to evaluate combined metric performance.ResultsTotal mortality was 9.4% and 9.1% in the development and test set, respectively. The final model included 12 PEC. In the test set, the PEC Risk Score (c-statistic: 79.7) was superior for predicting in-hospital and 90-day mortality compared with all other metrics. For in-hospital mortality alone, the PEC Risk Score similarly outperformed all other metrics. Combination of the PEC Risk Score and any injury-based metric significantly improved prediction compared with any injury-based metric alone.ConclusionOur 12-item PEC Risk Score performed well compared with other metrics, suggesting that the classification of trauma-related mortality risk may be improved through its use. Among non-severely injured older trauma patients, the utility of prognostic metrics may be enhanced through the incorporation of comorbidities.Copyright © 2018 Elsevier Inc. All rights reserved.

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