Aftercare following fatal traumatic injuries, needs and questions: a level 1 trauma center study and scoping review

Abstract

Purpose: Approximately 2,000 people die each year in the hospital due to accidental or inflicted traumatic injuries in the Netherlands. This has major emotional and socioeconomic consequences. Bereavement support is offered to prevent complicated grief, however, recommendations on adequate aftercare by the hospital are lacking.

Methods: Patients with fatal traumatic injuries admitted to the Northwest Clinics, Alkmaar, or Amsterdam University Medical Center, VUMC, between January 1st 2021, and January 1st 2023, were assessed for eligibility (Injury Severity Score ≥ 16, in-hospital mortality). Their relatives were contacted, and a questionnaire was administered to evaluate their experiences with the aftercare provided by the hospital. In addition, a scoping review was performed to report on recommendations to improve aftercare.

Results: A total of 1,131 articles were identified for the scoping review, of which 10 were selected for analysis (four questionnaires and six interview-based studies). The implementation of grief services by skilled professionals is recommended. The most frequently reported time between death and contact was 4-6 weeks, with contact conducted via telephone. During the study period, 110 patients met the inclusion criteria for the questionnaire. The median age of the deceased was 70 years (SD 20); 58% were male, with a median Injury Severity Score of 26 (range 16-75). Bereavement support was offered to 50% of the relatives, requested by 34%, and absent or lacking for 24%.

Conclusion: Aftercare following traum-related in-hospital deaths remains inconsistent. Both the questionnaire and scoping review recommend structured aftercare. Aftercare, by telephone or face-to-face, conducted by a trained professional four weeks after the death, is suggested to favorably influence the course of bereavement or lead to timely referral for grief counseling.

Keywords: Aftercare; Bereavement support; Grief; Questionnaire; Review; Trauma surgery.

Fig. 1

Flowchart of the search and selection procedure of studies ** PRISMA 2020 flow diagram template (PRISMA 2020 flow diagram — PRISMA statement (prisma-statement.org)

Fig. 2

Response rate: 44%, 32 of the relatives participated and 16 declined