{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T09:07:55Z","timestamp":1779786475553,"version":"3.53.1"},"reference-count":20,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background: This study aimed to evaluate the association between comorbidity and hospital admission, hospital length of stay (LOS), and in-hospital mortality among adult trauma patients across the injury severity spectrum in South Korea, and to assess whether these associations vary according to injury severity. Methods: We conducted a retrospective cohort study using the national Community-Based Severe Trauma Survey (2019\u20132023). Adult patients (\u226518 years) with trauma were included after excluding records with missing key exposure or outcome variables. Comorbidity was defined using the ICD-10\u2013based Elixhauser comorbidity framework. In addition to a binary classification (any vs. none), comorbidity burden was categorized into 0, 1, 2, and \u22653 conditions to evaluate dose\u2013response relationships. The primary outcomes were hospital admission, LOS, and in-hospital mortality. Multivariable logistic regression models were used for admission and mortality, and regression models were applied for LOS, adjusting for demographic characteristics, injury mechanism, physiologic status, and system-level factors. Effect modification by injury severity was assessed using interaction terms and ISS-stratified analyses. Results: Among 49,259 patients, 32,999 (67.0%) had at least one comorbidity. Patients with comorbidities were older, had higher injury severity, and showed higher admission rates, longer LOS, and higher in-hospital mortality compared with those without comorbidities. After adjustment, comorbidity remained independently associated with increased odds of admission, prolonged LOS, and in-hospital mortality. A dose\u2013response relationship was observed, with increasing comorbidity burden associated with progressively worse outcomes (p for trend &lt; 0.001). In addition, substantial heterogeneity was identified across individual comorbidities, with conditions such as metastatic cancer, liver disease, coagulopathy, renal disease, and fluid and electrolyte disorders showing stronger associations with adverse outcomes. The magnitude of these associations varied across ISS strata, indicating injury severity-dependent effects. Conclusions: In this nationwide cohort, comorbidity burden and type were important determinants of acute-care utilization and in-hospital mortality among trauma patients. Incorporating comorbidity information into early risk stratification may improve prognostic accuracy and support more efficient resource allocation and clinical decision-making across the trauma care continuum.<\/jats:p>","DOI":"10.3390\/healthcare14101380","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T14:40:31Z","timestamp":1779115231000},"page":"1380","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comorbidity Burden and Acute-Care Utilization in Adult Trauma Patients Across the Injury Severity Spectrum in a Nationwide Community-Based Survey (Korea, 2019\u20132023)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7903-753X","authenticated-orcid":false,"given":"Su-il","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Paramedicine, Yeungjin University, Daegu 41527, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1007-5987","authenticated-orcid":false,"given":"Sung Mo","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Paramedicine, Gwangju University, 277 Hyodeok-ro, Nam-gu, Gwangju 61743, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwang-Seok","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Paramedicine, Gwangju University, 277 Hyodeok-ro, Nam-gu, Gwangju 61743, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Soo","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Paramedicine, Gwangju University, 277 Hyodeok-ro, Nam-gu, Gwangju 61743, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7622-2594","authenticated-orcid":false,"given":"Min-Seok","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Health Administration, Yeungnam University College, Daegu 42415, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Seong","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Paramedicine, Busan Health University, Sari-ro 55 beon-gil, Saha-gu, Busan 49318, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Hye","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Paramedicine, Daewon University, 316 Daehak-ro, Jecheon-si 27135, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1596-9968","authenticated-orcid":false,"given":"Duk-Hee","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3691-4181","authenticated-orcid":false,"given":"Yun-Deok","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Paramedicine, Tongmyong University, Busan 48520, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. 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