title: The Charlson comorbidity index (CCI) for adjustment of hip fracture mortality in the elderly: analysis of the importance of recording secondary diagnoses.
abstract: This study evaluates the role of the number of secondary diagnoses for calculating the Charlson comorbidity index (CCI) in risk adjustment of the 90-day mortality rate after hip fracture surgical repair. Comorbidities were selected by reviewing the medical records of 390 patients 50 years of age or older in a teaching hospital in Rio de Janeiro from 1995 to 2000. Logistic regression models were fitted including the variables age, sex, and CCI. The CCI was calculated based on: (1) all patients' comorbidities; (2) only the comorbidity with the highest weight; and (3) a single randomly selected comorbidity. There was a gradient in the prediction of the CCI mortality rate when all comorbidities were used (OR = 6.53; 95%CI: 2.27-18.77, for scores >or= 3). The predictive capacity of the CCI was observed even when it was calculated using only one comorbidity: with the highest weight (OR = 2.83; 95%CI: 1.11-7.22); and randomly selected (OR = 2.90; 95%CI: 1.07-7.81). Using all comorbidities for CCI calculation is important. Severity indices based on a single comorbidity can be useful for risk adjustment procedures.
authors.affiliation: Fundação Educacional Serra dos Orgãos, Teresópolis, Brasil. romulocsouza@oi.com.br
authors.forename: Rômulo Cristovão de
authors.initials: RC
authors.lastname: Souza
authors.forename: Rejane Sobrino
authors.initials: RS
authors.lastname: Pinheiro
authors.forename: Cláudia Medina
authors.initials: CM
authors.lastname: Coeli
authors.forename: Kenneth Rochel de
authors.initials: KR
authors.lastname: Camargo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020379:Risk Adjustment / Q000379:methods*; D012720:Severity of Illness Index