The Australian Injury Comorbidity Indices (AICIs) to predict in-hospital complications: A population-based data linkage study

PLoS One. 2020 Sep 11;15(9):e0238182. doi: 10.1371/journal.pone.0238182. eCollection 2020.

Abstract

Background: Hospital-admitted patients are at risk of experiencing certain adverse outcomes during their hospital-stay. Patients may need to be admitted to the intensive care unit or be placed on the ventilator while there is also a possibility for complications to develop. Pre-existing comorbidity could increase the risk of these outcomes. The Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM), originally derived for mortality outcomes among general medical populations, are widely used for assessing these in-hospital complications even among specific injury populations. This study derived indices to specifically capture the effect of comorbidity on intensive care unit and ventilator use as well as hospital-acquired complications for injury patients.

Methods: Retrospective data on injury hospital-admissions from July 2012 to June 2014 (161,334 patients) for the state of Victoria, Australia was analysed. Results from multivariable regression analysis were used to derive the Australian Injury Comorbidity Indices (AICIs) for intensive care unit and ventilator hours and hospital-acquired complications. The AICIs, CCI and ECM were validated on data from Victoria and two other Australian states.

Results: Five comorbidities were significantly associated with intensive care unit hours, two with ventilator hours and fifteen with hospital-acquired complications for hospitalised injury patients. Not all diseases listed in the CCI or ECM were found to be associated with these outcomes. The AICIs performed equally well in terms of predictive ability to the long-listed ECM and in most instances outperformed the CCI.

Conclusions: Associations between outcomes and comorbidities vary based on the type of outcome measure. The new comorbidity indices developed in this study provide a relevant, parsimonious and up-to-date method to capture the effect of comorbidity on in-hospital complications among admitted injury patients and is better suited for use in that context compared to the CCI and ECM.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Australia
  • Child
  • Child, Preschool
  • Comorbidity*
  • Databases, Factual*
  • Female
  • Hospital Mortality
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units
  • Length of Stay
  • Male
  • Middle Aged
  • Retrospective Studies
  • Ventilators, Mechanical / adverse effects
  • Wounds and Injuries / complications
  • Wounds and Injuries / pathology
  • Young Adult

Grants and funding

This paper is part of a PhD thesis which is supported by the Victorian Injury Surveillance Unit (VISU) funded by the Victorian Government. The PhD student received the Australian Government Research Training Program scholarship stipend during the course of the project. This PhD project was initiated by VISU and therefore funds for purchasing data were supplied VISU. TF and JB are staff of VISU; however, the role of VISU was solely to be a source of data acquisition funding and supervision support. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.