title: Comorbidity-polypharmacy score predicts readmission in older trauma patients.
abstract: BACKGROUND
  Hospital readmissions are considered to be a measure of quality of care, correlate with worse outcomes, and may soon lead to decreased reimbursement. The comorbidity-polypharmacy score (CPS) is the sum of the number of preinjury medications and comorbidities, and may estimate patient frailty more effectively than patient age. This study evaluates the association between CPS and readmission.
  
  
  METHODS
  Medical records for trauma patients ≥45 y evaluated between January 1 and December 31, 2008, at our American College of Surgeons-verified level 1 trauma center were reviewed to obtain information on demographics, injuries, preinjury comorbidities, and medications, and occurrences of readmission to our facility within 30 d of discharge. Chi-square and Kruskal-Wallis testing was used to evaluate differences between readmitted and nonreadmitted patients, with multiple logistic regression used to evaluate the contribution of independent risk factors for readmission.
  
  
  RESULTS
  A total of 879 patients were included; their ages ranged from 45-103 y (median 58), injury severity scores from 0-50 y (median 5), and CPS from 0-39 y (median 7). A total of 76 patients (8.6%) were readmitted to our facility within 30 d of discharge. The readmitted cohort had higher CPS (median, 9.5, range 0-32, P = 0.031) and injury severity score (median, 9, range 1-38, P = 0.045), but no difference in age (median, 59.5, range 47-99, P = 0.646). Logistic regression demonstrated independent association of higher CPS with increased risk of readmission, with each CPS point increasing readmission likelihood by 3.5% (P = 0.03).
  
  
  CONCLUSIONS
  CPS appears to correlate well with readmissions within 30 d. Frailty defined by CPS was a significantly stronger predictor of readmission than was patient age. Early recognition of elevated CPS may improve discharge planning and help guide interventions to decrease readmission rates in older trauma patients.
authors.affiliation: The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Blain Chaise
authors.initials: BC
authors.lastname: Housley
authors.affiliation: Division of Trauma, Critical Care and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Stanislaw P A
authors.initials: SP
authors.lastname: Stawicki
authors.affiliation: Division of Trauma, Critical Care and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: David C
authors.initials: DC
authors.lastname: Evans
authors.affiliation: Division of Trauma, Critical Care and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio. Electronic address: christian.jones@osumc.edu.
authors.forename: Christian
authors.initials: C
authors.lastname: Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003661:Decision Support Techniques; D005260:Female; D016330:Frail Elderly; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019338:Polypharmacy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*
keywords: Elderly; Frailty; Quality; Readmission; Trauma