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. 2016 Feb;80(2):210-7.
doi: 10.1097/TA.0000000000000930.

Discovering the truth about life after discharge: Long-term trauma-related mortality

Rachael A Callcut  1 , Glenn Wakam, Amanda S Conroy, Lucy Z Kornblith, Benjamin M Howard, Eric M Campion, Mary F Nelson, Matthew W Mell, Mitchell J Cohen
Affiliations

Discovering the truth about life after discharge: Long-term trauma-related mortality

Rachael A Callcut et al. J Trauma Acute Care Surg. 2016 Feb.

Abstract

Background: Outcome after traumatic injury has typically been limited to the determination at time of discharge or brief follow-up. This study investigates the natural history of long-term survival after trauma.

Methods: All highest-level activation patients prospectively enrolled in an ongoing cohort study from 2005 to 2012 were selected. To allow for long-term follow-up, patients had to be enrolled at least 1 year before the latest available data from the National Death Index (NDI, 2013). Time and cause of mortality was determined based on death certificates. Survival status was determined by the latest date of either care in our institution or NDI query. Kaplan-Meier curves were created stratified for Injury Severity Score (ISS). Survival was compared with estimated actuarial survival based on age, sex, and race.

Results: A total of 908 highest-level activation patients (median ISS, 18) were followed up for a median 1.7 years (interquartile range 1.0-2.9; maximum, 9.8 years). Survival data were available on 99.8%. Overall survival was 73% (663 of 908). For those with at least 2-year follow-up, survival was only 62% (317 of 509). Severity of injury predicted long-term survival (p < 0.0001) with those having ISS of 25 or greater with the poorest outcome (57% survival at 5 years). For all ISS groups, survival was worse than predicted actuarial survival (p < 0.001). When excluding early deaths (≤30 days), observed survival was still significantly lower than estimated actuarial survival (p < 0.002). Eighteen percent (44 of 245 deaths) of all deaths occurred after 30 days. Among late deaths, 53% occurred between 31 days and 1 year after trauma. Trauma-related mortality was the leading cause of postdischarge death, accounting for 43% of the late deaths.

Conclusion: Postdischarge deaths represent a significant percentage of total trauma-related mortality. Despite having "survived" to leave the hospital, long-term survival was worse than predicted actuarial survival, suggesting that the mortality from injury does not end at "successful" hospital discharge.

Level of evidence: Prognostic study, level III.

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Figures

Figure 1
Figure 1
5 year Survival for Cohort stratified by injury severity score (ISS)
See this image and copyright information in PMC

References

    1. Norton R, Kobusingye O. Injuries. N Engl J Med. 2013 May 2;368(18):1723–1730. - PubMed
    1. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon J, Abdalla S, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2197–2223. - PubMed
    1. Weir S, Salkever DS, Rivara FP, Jurkovich GJ, Nathens AB, Mackenzie EJ. One-year treatment costs of trauma care in the USA. Expert Rev Pharmacoecon Outcomes Res. 2010 Apr;10(2):187–197. - PubMed
    1. Rogers FB, Osler T, Krasne M, Rogers A, Bradburn EH, Lee JC, Wu D, McWilliams N, Horst NA. Has TRISS become an anachronism? A comparison of mortality between the National Trauma Data Bank and Major Trauma Outcome Study databases. J Trauma Acute Care Surg. 2012 Aug;73(2):326–331. discussion 31. - PubMed
    1. Arias E. United States Life Tables. National Vital Statistics Reports 2010. 2010 - PubMed

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