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. 2015 Jun;30(3):656.e1-7.
doi: 10.1016/j.jcrc.2015.01.003. Epub 2015 Jan 8.

Quadrimodal distribution of death after trauma suggests that critical injury is a potentially terminal disease

Heena P Santry  1 , Charles M Psoinos  2 , Christopher J Wilbert  3 , Julie M Flahive  2 , Aimee R Kroll-Desrosiers  4 , Timothy A Emhoff  2 , Catarina I Kiefe  4
Affiliations

Quadrimodal distribution of death after trauma suggests that critical injury is a potentially terminal disease

Heena P Santry et al. J Crit Care. 2015 Jun.

Abstract

Background: Patterns of death after trauma are changing due to advances in critical care. We examined mortality in critically injured patients who survived index hospitalization.

Methods: Retrospective analysis of adults admitted to a Level-1 trauma center (1/1/2000-12/31/2010) with critical injury was conducted comparing patient characteristics, injury, and resource utilization between those who died during follow-up and survivors.

Results: Of 1,695 critically injured patients, 1,135 (67.0%) were discharged alive. As of 5/1/2012, 977/1,135 (86.0%) remained alive; 75/158 (47.5%) patients who died during follow-up, died in the first year. Patients who died had longer hospital stays (24 vs. 17 days) and ICU LOS (17 vs. 8 days), were more likely to undergo tracheostomies (36% vs. 16%) and gastrostomies (39% vs. 16%) and to be discharged to rehabilitation (76% vs. 63%) or skilled nursing (13% vs. 5.8%) facilities than survivors. In multivariable models, male sex, older age, and longer ICU LOS predicted mortality. Patients with ICU LOS >16 days had 1.66 odds of 1-year mortality vs. those with shorter ICU stays.

Conclusions: ICU LOS during index hospitalization is associated with post-discharge mortality. Patients with prolonged ICU stays after surviving critical injury may benefit from detailed discussions about goals of care after discharge.

Keywords: Critical injury; Goals of care; Injury mortality; Trauma mortality.

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Conflict of interest statement

Conflict of Interest

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Figures

Figure 1
Figure 1
Mortality among critically injured* non-pregnant adult (age ≥18 years) trauma patients (2000–2010) shown relative to conceptual model of a quadrimodal distribution of death after injury. * Injury Severity Score ≥25. † Study follow-up closed on May 1, 2011 for a median follow-up of 62 (IQR 35, 96) months. ‡ We propose that these patients are those for whom critical injury is a terminal disease.
Figure 2
Figure 2
Distribution of deaths by decade for critically injured adult trauma patients (2000–2010) who survived index hospitalization (n = 158).
Figure 3
Figure 3
Kaplan–Meier survival curves for critically injured adult trauma patients (2000–2010) who survived index hospitalization, by ICU stay ≤16 vs. >16 days (n = 1,135).
See this image and copyright information in PMC

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