The Impact of Select Chronic Diseases on Outcomes after Trauma: A Study from the National Trauma Data Bank

BACKGROUND: Data regarding pre-existing comorbidities is often poorly recorded in trauma registries, and reports of their impact on outcomes are conflicting. Additionally, many previous reports, when conducting data analysis, do not reliably account for differences in case and control cohorts. Our objective was to identify a subset of patients with reliable comorbidity and complication data in the National Trauma Data Bank (NTDB) in order to determine the impact of select chronic organ system dysfunction on morbidity and mortality using case-control methodology. STUDY DESIGN: We analyzed a refined dataset from NTDB 7.1 (2002 to 2006) containing admissions to Level 1 and 2 trauma centers, which specified using chart abstraction to document comorbidities and complications. Patients with a history of cirrhosis, dialysis, HIV, and warfarin therapy were compared with a 2:1 case-matched control group. Data regarding age; Injury Severity Score (ISS); ventilator, ICU, and hospital lengths of stay; complications; and mortality were obtained. Pearson's chi-square, Fisher's exact test, and the t-test were used to compare demographics and outcomes of each comorbidity group. A p value < 0.05 was considered significant. RESULTS: After case-control matching, pre-existing cirrhosis, dialysis, and warfarin therapy were found to be risk factors for both complications and mortality; HIV/AIDS was found to be a risk factor only for complications. CONCLUSIONS: Chronic hepatic failure, end-stage renal disease, immunodeficiency, and acquired coagulopathy are associated with higher resource use, complication rates, and mortality in a refined subset of NTDB patients. (J Am Coll Surg 2011;212:96-104. (C) 2011 by the American College of Surgeons)