High mortality rates seen in trauma patients several years after injury

A study of more than 120,000 adults treated for trauma during a 13-year period found 16% died within 3 years of their injury compared with an expected population mortality rate of about 6%, according to a press release from the Journal of the American Medical Association.

The investigators, led by Giana H. Davidson, MD, MPH, of the Harborview Injury Prevention and Research Center in Seattle also found that trauma patients who were discharged to a skilled nursing facility had a significantly increased risk of death compared with patients discharged home without assistance.

“Information on the short- and long-term causes of death following discharge for injury could potentially identify gaps in care amenable to improvement, and allow for counseling of patients and their families about prognosis following traumatic injuries,” Davidson and colleagues wrote in the article.

To determine the long-term mortality of trauma patients and indentify predictors that increase risk for death following hospital discharge, the investigators studied 124,421 patients who were injured between January 1995 and December 2008. The investigators linked information they obtained from the Washington State Trauma Registry data to death certificate data.

The investigators found that 7,243 patients died during their trauma hospitalization, and 21,045 patients died following hospital discharge. While the proportion of patients who died while in-hospital declined for each year of the study from 8% in 1995 to about 4.9% in 2008, long-term cumulative mortality increased from 4.7% to 7.4%. Cumulative mortality was 9.8% at 1-year post-injury vs. 16% at 3-years post-injury, according to the press release.

“Overall, cumulative mortality was significantly lower for those patients discharged home with or without assistance and patients discharged to rehabilitation facilities than for patients discharged to a skilled nursing facility, who had a 34% cumulative mortality by 3 years postdischarge,” the investigators wrote.

The study also revealed other significant predictors for mortality after discharge, such as, a maximum score on a head injury scale, the measure of functional independence, whether a fall was the mechanism of injury and having Medicare or other government insurance.

“Interventions should be aimed at improving the care of the injured patient following discharge from the hospital and narrow the gap in outcomes for those patients discharged to skilled nursing facilities,” Davidson and colleagues wrote.

References:
Davidson GH, et al. JAMA. 2011;305(10):1001-1007.
Disclosure: She has no relevant financial disclosures. This work was supported by National Institute of Child Health and Human Development grant 1T32HD057822-01AZ that was awarded to the Pediatric Injury Research Training Program.

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