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. 2016 Jul;47(7):1393-403.
doi: 10.1016/j.injury.2016.04.002. Epub 2016 Apr 22.

Traumatic injury in the United States: In-patient epidemiology 2000-2011

Charles DiMaggio  1 , Patricia Ayoung-Chee  2 , Matthew Shinseki  2 , Chad Wilson  2 , Gary Marshall  2 , David C Lee  3 , Stephen Wall  4 , Shale Maulana  2 , H Leon Pachter  2 , Spiros Frangos  2
Affiliations

Traumatic injury in the United States: In-patient epidemiology 2000-2011

Charles DiMaggio et al. Injury. 2016 Jul.

Abstract

Background: Trauma is a leading cause of death and disability in the United States (US). This analysis describes trends and annual changes in in-hospital trauma morbidity and mortality; evaluates changes in age and gender specific outcomes, diagnoses, causes of injury, injury severity and surgical procedures performed; and examines the role of teaching hospitals and Level 1 trauma centres in the care of severely injured patients.

Methods: We conducted a retrospective descriptive and analytic epidemiologic study of an inpatient database representing 20,659,684 traumatic injury discharges from US hospitals between 2000 and 2011. The main outcomes and measures were survey-adjusted counts, proportions, means, standard errors, and 95% confidence intervals. We plotted time series of yearly data with overlying loess smoothing, created tables of proportions of common injuries and surgical procedures, and conducted survey-adjusted logistic regression analysis for the effect of year on the odds of in-hospital death with control variables for age, gender, weekday vs. weekend admission, trauma-centre status, teaching-hospital status, injury severity and Charlson index score.

Results: The mean age of a person discharged from a US hospital with a trauma diagnosis increased from 54.08 (s.e.=0.71) in 2000 to 59.58 (s.e.=0.79) in 2011. Persons age 45-64 were the only age group to experience increasing rates of hospital discharges for trauma. The proportion of trauma discharges with a Charlson Comorbidity Index score greater than or equal to 3 nearly tripled from 0.048 (s.e.=0.0015) of all traumatic injury discharges in 2000 to 0.139 (s.e.=0.005) in 2011. The proportion of patients with traumatic injury classified as severe increased from 22% of all trauma discharges in 2000 (95% CI 21, 24) to 28% in 2011 (95% CI 26, 30). Level 1 trauma centres accounted for approximately 3.3% of hospitals. The proportion of severely injured trauma discharges from Level 1 trauma centres was 39.4% (95% CI 36.8, 42.1). Falls, followed by motor-vehicle crashes, were the most common causes of all injuries. The total cost of trauma-related inpatient care between 2001 and 2011 in the US was $240.7 billion (95% CI 231.0, 250.5). Annual total US inpatient trauma-related hospital costs increased each year between 2001 and 2011, more than doubling from $12.0 billion (95% CI 10.5, 13.4) in 2001 to 29.1 billion (95% CI 25.2, 32.9) in 2011.

Conclusions: Trauma, which has traditionally been viewed as a predicament of the young, is increasingly a disease of the old. The strain of managing the progressively complex and costly care associated with this shift rests with a small number of trauma centres. Optimal care of injured patients requires a reappraisal of the resources required to effectively provide it given a mounting burden.

Keywords: Epidemiology; Injury; Trauma.

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Conflict of interest statement

Conflict of Interest. The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Annual Traumatic Injury Hospital Admission Rates per 100,000 Population with Overlying Loess Smoothing Line and Confidence Envelope. US Census Regions, 2000–2011.
Figure 2
Figure 2
Annual Traumatic Injury Hospital Admission Rates per 100,000 Population with Overlying Loess Smoothing Line and Confidence Envelope. Children and Young Adults. US, 2000–2011.
Figure 3
Figure 3
Proportion of Discharges with Charlson Index Score > 2 by Age Group. Inpatient Traumatic Injury Discharges, US Hospitals, 2003–2011.
Figure 4
Figure 4
Case-Fatality Ratio, All Ages. Inpatient Traumatic Injury Discharges, US Hospitals, 2003–2011.
Figure 5
Figure 5
Annual Proportion of Hospital Trauma Discharges Classified as Severe. US, 2000 to 2011.
Figure 6
Figure 6
Proportion of Traumatic Injuries Classifed as Severe Over Time, by Age Group. US, 2000 to 2011.
Figure 7
Figure 7
Percentage of Annual Traumatic Injury Discharges Classified as TBI by Age Group. US Hospitals 2000–2011.
Figure 8
Figure 8
Pareto Chart 10 Most Frequent Inpatient Procedures, Severely Injured vs. All Trauma Inpatient Discharges. US Hospitals, 2000–2011.
Figure 9
Figure 9
Cost of Inpatient Care Traumatic Injuries, US Hospitals 2001–2011
See this image and copyright information in PMC

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