title: Assessing the ability of comorbidity indexes to capture comorbid disease in the inpatient rehabilitation burn injury population.
abstract: OBJECTIVE
  Burn patients exhibit comorbidities that influence outcomes. This study examines whether existing comorbidity measures capture comorbidities in the burn inpatient rehabilitation population.
  
  
  METHODS
  Data were obtained from the Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury. International Classification of Diseases, 9th Revision, codes were used to assess three comorbidity measures (Charlson Comorbidity Index, Elixhauser Comorbidity Index, Centers for Medicare and Medicaid Services Comorbidity Tiers). The number of subjects and unique comorbidity codes (>1% of frequency) captured by each comorbidity measure was calculated.
  
  
  RESULTS
  The study included 5347 patients with a median total body surface area burn decile of 20%-29%, mean age of 51.6 yrs, and mean number of comorbidities of 7.6. There were 2809 unique International Classification of Diseases, 9th Revision, comorbidity codes. The Charlson Comorbidity Index, Elixhauser Comorbidity Index, and Centers for Medicare and Medicaid Services Comorbidity Tiers did not capture 67%, 27%, and 58% of the subjects, respectively. There were 107 unique comorbidities that occurred with a frequency of greater than 1%. Of these, 67% were not captured in all three comorbidity measures.
  
  
  CONCLUSIONS
  Commonly used comorbidity indexes do not reflect the extent of comorbid disease in the burn rehabilitation population. Future work is needed to assess the need for comorbidity indexes specific to the inpatient rehabilitation setting.
authors.affiliation: From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts (CSS, RG, PG, RZ, JCS); Uniform Data System for Medical Rehabilitation, Amherst, New York (MAD, JM, PN); Health Care Studies Department, Daemen College, Amherst, New York (PN); Department of Surgery, Shriners Hospitals for Children-Boston, Massachusetts (RS, CMR); Surgical Services, Sumner Redstone Burn Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (RS, CMR); and Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas, Texas (KJK).
authors.forename: Chloe S
authors.initials: CS
authors.lastname: Slocum
authors.forename: Richard
authors.initials: R
authors.lastname: Goldstein
authors.forename: Margaret A
authors.initials: MA
authors.lastname: DiVita
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Mix
authors.forename: Paulette
authors.initials: P
authors.lastname: Niewczyk
authors.forename: Paul
authors.initials: P
authors.lastname: Gerrard
authors.forename: Robert
authors.initials: R
authors.lastname: Sheridan
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Kowalske
authors.forename: Ross
authors.initials: R
authors.lastname: Zafonte
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Ryan
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000453:epidemiology* / Q000534:rehabilitation*; D015897:Comorbidity / Q000639:trends*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D055815:Young Adult