외상 환자의 기저질환이 입원율, 입원 기간, 사망률에 미치는 영향 = The Impact of Comorbidities on Hospitalization Rate, Length of Stay, and Mortality in Trauma Patients

다국어 초록 (Multilingual Abstract)

Background: Trauma remains a leading cause of death and disability, and clinical
outcomes are substantially affected by pre-existing comorbidities. In South Korea, the
burden of chronic disease among trauma patients is increasing with population aging;
however, nationwide evidence quantifying the impact of comorbidity on key trauma
outcomes remains limited. This study evaluated the association between comorbidity and
hospital admission, length of stay (LOS), and in-hospital mortality using a nationwide
community-based severe trauma dataset.
Methods: This retrospective cohort study analyzed 49,259 trauma patients from the 2016
–2023 Community-Based Severe Trauma Survey. Comorbidities were defined using the
ICD-10–based Elixhauser Comorbidity Index and categorized as presence/absence, type,
and number of comorbidities. Outcomes included hospital admission, LOS (days), and
in-hospital mortality. Multivariable logistic regression was used for admission and
mortality, and multivariable linear regression was used for LOS. Additional analyses
included ANCOVA to examine the independent effect of comorbidity on LOS after
covariate adjustment, and stratified analyses by Injury Severity Score (ISS) groups (1–
* A thesis submitted to the Council of the Graduate School of KyungPook National University in Partial
fulfillment of the requirements for the degree of Ph.D in December 2025

8, 9–15, 16–24, ≥25). Models adjusted for clinically relevant covariates including age,
sex, injury mechanism, injury severity, and physiologic and system-level factors.
Results: Of the 49,259 patients, 32,999 (67.0%) had at least one comorbidity. Compared
with patients without comorbidity, those with comorbidity had higher admission rates
(79.8% vs. 73.3%, p<0.001), longer LOS (median 36 [IQR 2–62] vs. 28 [IQR 2–58]
days, p=0.002), and higher in-hospital mortality (2.5% vs. 1.8%, p<0.001). After
adjustment, comorbidity was associated with increased odds of admission (OR 1.42, 95%
CI 1.25–1.61) and mortality (OR 1.75, 95% CI 1.45–2.10). Comorbidity was also
independently associated with prolonged LOS (β +2.8 days, 95% CI 1.9–3.7, p<0.001). In
ISS-stratified analyses, the adverse effect of comorbidity was more pronounced with
increasing injury severity: adjusted mortality ORs increased from 1.22 (ISS 1–8) to 2.41
(ISS ≥25), while LOS increased by +1.2, +1.9, +3.1, and +4.5 days across the four ISS
strata (all p<0.001 for LOS). Several comorbidities—particularly congestive heart failure,
renal disease, liver disease, coagulopathy, fluid/electrolyte disorders, and metastatic
cancer—showed strong associations with higher mortality and longer LOS.
Conclusion: Comorbidity is a significant and independent determinant of worse trauma
outcomes, associated with higher admission rates, prolonged hospitalization, and
increased in-hospital mortality. The magnitude of these associations increases with
trauma severity, supporting the integration of structured comorbidity assessment into
trauma triage, risk stratification, and resource allocation. Incorporating comorbidity
measures into trauma outcome prediction models may improve prognostic accuracy and
guide targeted management for high-risk patients.
Key words: Trauma, Comorbidity, Hospitalization, Emergency department, Mortality

목차 (Table of Contents)

• Ⅰ. 서 론 1
• II. 대상 및 방법 3
• 1. 연구설계 3
• 2. 연구 대상 수집 방법 3
• 3. 변수의 정의 5
• 4. 통계 분석 10
• Ⅲ. 연구 결과 12
• 1. 연구대상자들의 인구학적 특성 12
• 2. 기저질환 유무에 따른 외상환자의 인구학적 특성 비교 16
• 3. 기저질환 유무에 따라 외상환자의 입원율과 사망률, 입원 기간에 미치는 영향 ·· 19
• 4. 기저질환 별 외상환자의 입원율과 사망률, 입원 기간에 미치는 영향 20
• 5. 기저질환 유형 및 수에 따른 입원, 병원 내 사망, 입원 기간의 차이 23
• 6. 손상 점수 그룹별 입원율, 사망률, 입원 기간에 미치는 영향 26
• Ⅳ. 고찰 30
• Ⅴ. 결 론 34
• 참고 문헌 36
• 부 록 42