Even if they survive the initial hospitalization, those who suffer a traumatic injury are more likely to die within the next three years than people in the general population, a newly released study shows.
Among the 120,000-plus patients treated at trauma centers in Washington State, the cumulative three-year mortality rate was 16 percent—substantially higher than the 5.9 percent expected in the general population after controlling for age and sex, reported Dr. Saman Arbabi, the co-author of the study in the March 9 issue of the Journal of the American Medical Association.
“This information can help guide clinician and family decision making for the adult trauma patient,” the study noted. “These results suggest that in an adult trauma patient, acute injury is not just a brief physiological setback to a healthy life, but rather signals significant long-term mortality in a large number of patients.”
For their study, Arbabi and his colleagues examined mortality rates among 124,421 patients over age 18 admitted to any one of the state’s 78 designated trauma centers from January 1995 to December 2008.
The mean age of the patients was 53 and almost 59 percent were male.
Overall, 5.8 percent of trauma patients died before leaving the hospital—although that rate dropped from 8 percent in 1995 to 4.9 percent in 2008, possibly “due to maturation of the trauma system in Washington State,” the researchers noted.
However, despite the improvement in hospital mortality, the percentage of patients who died within one year of discharge increased from 4.7 percent to 7.4 percent.
Most patients were discharged to home, with or without assistance, and another 24.7 percent were discharged to a skilled nursing facility.
The patients discharged to a nursing facility had a higher three-year mortality rate (34 percent) than those discharged elsewhere—the next highest was among those discharged to home with assistance (15.9 percent).
After adjustment for confounders, including functional status, age ≥31 was the strongest predictor of death Discharge to a skilled nursing facility was a strong predictor of death as well, a finding consistent across all age groups, except for patients ages 18 to 30.
“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,” Arbabi and his colleagues wrote.
“Further investigation is needed to determine if more health clinician oversight, funding, or rehabilitation therapy is needed to improve the care of the patients at skilled nursing facilities following discharge for injury,” they added.
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