Long term mortality following trauma

January 01, 0001

Long term mortality following trauma

Significant improvements have been made in acute treatment of trauma patients. However, there is a paucity of data on long term mortality following trauma. These US researchers examined the long-term mortality of patients following trauma hospitalization and sought to identify risk factors. They performed a retrospective cohort study involving adult trauma patients (n= 124 421) using the Washington State Trauma Registry and data from death certificates.

The researchers found: "Of the 124,421 trauma patients, 7243 died before hospital discharge and 21 045 died following hospital discharge. Cumulative mortality at 3 years postinjury was 16% compared with the expected population cumulative mortality of 5.9%. In-hospital mortality improved during the 14-year study period from 8% (n = 362) to 4.9% (n = 600), whereas long-term cumulative mortality increased from 4.7% (to 7.4%). After adjustments for confounders, patients who were older and those who were discharged to a skilled nursing facility had the highest risk of death… Other significant predictors of mortality after discharge included maximum head injury score on Abbreviated Injury Score scale (HR, 1.20), Injury Severity Score (HR, 0.98), Functional Independence Measure (HR, 0.89), mechanism of injury being a fall (HR, 1.43), and having Medicare (HR, 1.28) or other government insurance (HR, 1.65)."

The researchers concluded: "Among adults admitted for trauma in Washington State, 3-year cumulative mortality was 16% despite a decline in in- hospital deaths. Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality."

Trauma requiring hospitalizatio has an appreciable mortality risk in the three years following hospital discharge

For the full abstract, click here.

JAMA 305(10):1001-1007, 9 March 2011
© 2011 American Medical Association
Long-term Survival of Adult Trauma Patients. Giana H. Davidson, Christian A. Hamlat, Frederick P. Rivara, Thomas D. Koepsell, Gregory J. Jurkovich, Saman Arbabi.

Category: A. General/Unspecified. Keywords: trauma, hospitalization, mortality, extended care facility, head trauma, retrospective cohort, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 29 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.