OBJECTIVE To examine whether commonly used comorbidity indexes (Deyo-Charlson comorbidity index, Elixhauser comorbidity index, and the Centers for Medicare and Medicaid Services (CMS) comorbidity tiers) capture comorbidities in the acute traumatic and nontraumatic SCI inpatient rehabilitation population. DESIGN Retrospective cross-sectional study PARTICIPANTS: Data were obtained from the Uniform Data System for Medical Rehabilitation from October 1, 2015 to December 31, 2017 for adults with SCI (Medicare-established Impairment Group Codes 04.110-04.230, 14.1, 14.3). This study included 66,235 SCI discharges from 833 inpatient rehabilitation facilities. MAIN OUTCOME MEASURE(S) International Classification of Diseases, 10th Revision, (ICD-10-CM) codes were used to assess three comorbidity indexes (Deyo-Charlson comorbidity index, Elixhauser comorbidity index, CMS comorbidity tiers). The comorbidity codes that occurred with >1% frequency were reported. The percentages of discharges for which no comorbidities were captured by each comorbidity index were calculated. RESULTS Of the total study population, 39,285 (59.3%) were male and 11,476 (17.3%) were tetraplegic. The mean number of comorbidities was 14.7. There were 13,939 distinct ICD-10-CM comorbidity codes. There were 237 comorbidities that occurred with >1% frequency. The Deyo-Charlson comorbidity index, Elixhauser comorbidity index, and the CMS tiers did not capture comorbidities of 58.4% (95% CI 58.08-58.84), 29.4% (29.07-29.76), and 66.1% (65.73-66.46) of the discharges in our study, respectively, and 28.8% (28.42-29.11) of the discharges did not have any comorbidities captured by any of the comorbidity indexes. CONCLUSION Commonly used comorbidity indexes do not reflect the extent of comorbid disease in the SCI rehabilitation population. This work suggests that alternative measures may be needed to capture the complexity of this population.

中文翻译：

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评估合并症指数捕捉住院康复脊髓损伤人群合并症的能力

目的 旨在检查常用的合并症指数（Deyo-Charlson 合并症指数、Elixhauser 合并症指数和医疗保险和医疗补助服务中心 (CMS) 合并症等级）是否捕获了急性创伤性和非创伤性 SCI 住院康复人群中的合并症。设计 回顾性横断面研究 参与者：数据来自 2015 年 10 月 1 日至 2017 年 12 月 31 日期间的医疗康复统一数据系统（Medicare 建立的损伤组代码 04.110-04.230、14.1、14.3）。该研究包括来自 833 家住院康复设施的 66,235 名 SCI 出院患者。主要结果测量（S）国际疾病分类第 10 版（ICD-10-CM）代码用于评估三个合并症指数（Deyo-Charlson 合并症指数、Elixhauser 合并症指数、CMS 合并症等级）。报告了发生频率 > 1% 的合并症代码。计算每个合并症指数未捕获到的出院百分比。结果 在整个研究人群中，39,285 (59.3%) 为男性，11,476 (17.3%) 为四肢瘫痪。合并症的平均数为 14.7。有 13,939 个不同的 ICD-10-CM 合并症代码。有 237 种合并症以 >1% 的频率发生。Deyo-Charlson 合并症指数、Elixhauser 合并症指数和 CMS 等级未涵盖 58.4% (95% CI 58.08-58.84)、29.4% (29.07-29.76) 和 66.1% (66.76) 的合并症在我们的研究中，分别为 28.8% (28.42-29. 11) 出院没有任何合并症指标捕获的合并症。结论 常用的合并症指标不能反映 SCI 康复人群合并症的程度。这项工作表明，可能需要采取替代措施来捕捉这一群体的复杂性。