Trauma patients have higher rate of death for several years following injury

Mar 08, 2011

In a study that included more than 120,000 adults who were treated for trauma, 16 percent of these patients died within 3 years of their injury, compared to an expected population mortality rate of about 6 percent, according to a study in the March 9 issue of JAMA. The researchers 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.

Trauma can lead to significant illness or death. "To date, there have been few large studies evaluating long-term mortality in and identifying predictors that increase risk for death following discharge," according to background information in the article. "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."

Giana H. Davidson, M.D., M.P.H., of the Harborview Injury Prevention and Research Center, Seattle, and colleagues conducted a study to examine the long-term mortality of Washington State trauma patients and to identify for death following hospital discharge. The study included 124,421 injured adult patients, from January 1995 to December 2008, and used the Washington State Trauma Registry linked to death certificate data. The average age of the patients was 53 years; 59 percent were male.

Of the patients in the study, 7,243 died (5.8 percent) during their trauma hospitalization; 21,045 died following . The proportion of patients who died while in the hospital declined each year of the study, from 8 percent in 1995 to approximately 4.9 percent in 2008, whereas long-term cumulative mortality increased from 4.7 percent to 7.4 percent. Analysis indicated that cumulative mortality following injury was 9.8 percent at 1 year and 16 percent at 3 years. Age and discharge to a skilled nursing facility strongly predicted risk of death during the follow-up period and time to death following injury.

Among patients discharged from the hospital, more than half were discharged home without assistance and nearly one-quarter were discharged to a skilled nursing facility. "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 percent cumulative mortality by 3 years postdischarge," the authors write.

"… our results indicate that skilled nursing facility discharge status may at least be a marker for significantly higher risk of subsequent mortality and may be the focus for future research and intervention, especially in the age group of 31- to 80-year-olds. There are significant differences in physical therapy and occupational therapy for patients in rehabilitation programs compared with patients at skilled nursing facilities, even when comparing similar demographic characteristics and medical complexity."

Other significant predictors of death after discharge included a maximum score for head injury on an injury scale, a measure of functional independence, the mechanism for injury being a fall, and having Medicare or other government insurance.

The researchers add that future research in surgical patients should focus on outcomes longer than the standard reporting of 30-day mortality because a downwind shift in mortality may be occurring from improvements in the acute care period. "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."

Explore further: Researchers compare hip width and sexual behavior

More information: JAMA. 2011;305[10]:1001-1007.

add to favorites email to friend print save as pdf

Related Stories

Diabetics experience more complications following trauma

Jul 16, 2007

Individuals with diabetes appear to spend more days in the intensive care unit, use more ventilator support and have more complications during hospitalization for trauma than non-diabetics, according to a report in the July ...

Kidney injury in hospital increases long-term risk of death

Dec 17, 2009

Patients with sudden loss of kidney function, called acute kidney injury (AKI), are more likely to die prematurely after leaving the hospital—even if their kidney function has apparently recovered, according to an upcoming ...

Elderly spinal cord injuries increase five-fold in 30 years

Mar 19, 2007

The number of spinal cord injuries among senior citizens (age 70 and above) has increased five times in the past 30 years, as compared with younger spinal cord injury patients, researchers at Thomas Jefferson University Hospital ...

Recommended for you

Rising role seen for health education specialists

24 minutes ago

(HealthDay)—A health education specialist can help family practices implement quality improvement projects with limited additional financial resources, according to an article published in the March/April ...

FDA proposes first regulations for e-cigarettes

55 minutes ago

The federal government wants to prohibit sales of electronic cigarettes to minors and require approval for new products and health warning labels under regulations being proposed by the Food and Drug Administration.

Vermont moves toward labeling of GMO foods

59 minutes ago

Vermont lawmakers have passed the country's first state bill to require the labeling of genetically modified foods as such, setting up a war between the behemoth U.S. food industry and an American public that overwhelmingly ...

User comments : 0

More news stories

FDA proposes first regulations for e-cigarettes

The federal government wants to prohibit sales of electronic cigarettes to minors and require approval for new products and health warning labels under regulations being proposed by the Food and Drug Administration.

When things get glassy, molecules go fractal

Colorful church windows, beads on a necklace and many of our favorite plastics share something in common—they all belong to a state of matter known as glasses. School children learn the difference between ...

FCC to propose pay-for-priority Internet standards

The Federal Communications Commission is set to propose new open Internet rules that would allow content companies to pay for faster delivery over the so-called "last mile" connection to people's homes.

SK Hynix posts Q1 surge in net profit

South Korea's SK Hynix Inc said Thursday its first-quarter net profit surged nearly 350 percent from the previous year on a spike in sales of PC memory chips.

Brazil enacts Internet 'Bill of Rights'

Brazil's president signed into law on Wednesday a "Bill of Rights" for the digital age that aims to protect online privacy and promote the Internet as a public utility by barring telecommunications companies ...