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Comorbidity-Polypharmacy Score Validated


Patients experiencing severe injuries are on average older than ever, but not every older patient is the same.  A patient, for instance, who is 55 years old but has diabetes, heart disease, and high blood pressure, and is on a slew of daily medications may be considered "physiologically older" than a healthy 65-year-old.  That's the basis behind the Comorbidity-Polypharmacy Score, or CPS, developed by doctors at The Ohio State University Wexner Medical Center and first described in 2013.

The score calculation is easy: simply add the number of pre-injury medical problems to the number of pre-injury medications, and the result is the CPS. CPS was designed as a a basic method for evaluating the "frailty" of patients over 45 and was quickly established as a good indicator of patient outcomes; older patients with higher CPS had more complications, longer stays in the hospital, and were more likely to be discharged to a skilled nursing facility or extended care facility than those of the same age but a lower CPS, even with the same severity of injuries. 

The Ohio State University Wexner Medical Center Division of Trauma, Critical Care and Burn treats hundreds of patients over 45 each year for injuries, and the surgeons in the division along with anesthesiologists and pharmacists from the surgical intensive care unit developed the CPS.  The greatest weakness of the formula, however, was that it was only in use at OSU and only evaluated using OSU patients.  Other institutions have compared it with similar formulas, but no other academic center had evaluated the CPS system in its own patients to demonstrate its reliability.

That's changed, now that Stanislaw Stawicki, MD, has published "Comorbidity–Polypharmacy Score as Predictor of Outcomes in Older Trauma Patients: A Retrospective Validation Study" in the March issue of World Journal of Surgery. Stawicki, part of the original team developing CPS at OSU, moved to St. Luke's University Hospital in Bethlehem, Pennsylvania, to become chair of the Department of Research & Innovation there in 2014.  He then led a team to evaluate the impact of CPS on patient outcomes, reviewing the records of over 5,000 patients and confirming that patients with higher CPS had longer hospital stays, more complications, and were more likely to be discharged somewhere other than home.

This is the first study to validate CPS as an important contribution of the OSU Division of Trauma, Critical Care and Burn to the wide treatment of injured patients.  More evaluations of CPS are expected from OSU and from other centers as the average age of trauma patients continues to climb.