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Improvement in trauma management requires a better understanding of the effect of a patient's preinjury health status on outcome. Specific historical findings and laboratory criteria were used to define pre-existing disease (PED) states and determine if they were independent predictors of fate in trauma victims. Of 7,798 adult patients admitted to a level I trauma center from July 1986 through June 1990, 16.0% (1,246) had ≥1 PED. The PED+ and PED-patients had no significant difference in Injury Severity Scores (ISSs) (15.7 versus 15.6) and admission Glasgow Coma Scale (GCS) scores (13.9 versus 13.8). The PED+ patients were older (49.2 versus 30.6 years) (p < 0.001) and had a higher mortality rate (9.2% versus 3.2%) (p < 0.001) than PED-patients. Mortality rates were also elevated for patients with ≥2 PEDs (18%) and for those with renal disease (38%), malignancy (20%), and cardiac disease (18%) (p < 0.001) compared with PED- patients. Controlling for age and ISS, there was an association between PED and mortality (Mantel-Haenszel p < 0.03). Multivariate regression showed that PED is an independent predictor of mortality (R2 = 0.1918; p < 0.0001). The greatest increases in mortality were found among patients <55 years and with ISS <20. Changes in prehospital triage criteria and outcome scoring are needed. Improvements in the management of trauma victims with chronic disease may decrease their mortality rate.
Milzman et al. (Sat,) studied this question.