TY - JOUR
T1 - Chronic consequences of acute injuries
T2 - Worse survival after discharge
AU - Shafi, Shahid
AU - Renfro, Lindsay A.
AU - Barnes, Sunni
AU - Rayan, Nadine
AU - Gentilello, Larry M.
AU - Fleming, Neil
AU - Ballard, David
PY - 2012/9
Y1 - 2012/9
N2 - Background: The Trauma Quality Improvement Program uses inhospital mortality to measure quality of care, which assumes patients who survive injury are not likely to suffer higher mortality after discharge. We hypothesized that survival rates in trauma patients who survive to discharge remain stable afterward. Methods: Patients treated at an urban Level I trauma center (2006-2008) were linked with the Social Security Administration Death Master File. Survival rates were measured at 30, 90, and 180 days and 1 and 2 years from injury among two groups of trauma patients who survived to discharge: major trauma (Abbreviated Injury Scale score Q 3 injuries, n = 2,238) and minor trauma (Abbreviated Injury Scale score e 2 injuries, n = 1,171). Control groups matched to each trauma group by age and sex were simulated from the US general population using annual survival probabilities from census data. Kaplan-Meier and log-rank analyses conditional upon survival to each time point were used to determine changes in risk of mortality after discharge. Cox proportional hazards models with left truncation at the time of discharge were used to determine independent predictors of mortality after discharge. Results: The survival rate in trauma patients with major injuries was 92% at 30 days posttrauma and declined to 84% by 3 years (p 9 0.05 compared with general population). Minor trauma patients experienced a survival rate similar to the general population. Age and injury severity were the only independent predictor so f long-termmortality given survival to discharge. Log-ranktests conditional on survival to each time point showed that mortality risk in patients with major injuries remained significantly higher than the general population for up to 6 months after injury. Conclusion: Thesurvival rateoftrauma patientswithmajorinjuriesremainssignificantlylower thansurvival for minor traumapatientsand the general population for several months postdischarge. Surveillance for early identification and treatment of complications may be needed for trauma patients with major injuries.
AB - Background: The Trauma Quality Improvement Program uses inhospital mortality to measure quality of care, which assumes patients who survive injury are not likely to suffer higher mortality after discharge. We hypothesized that survival rates in trauma patients who survive to discharge remain stable afterward. Methods: Patients treated at an urban Level I trauma center (2006-2008) were linked with the Social Security Administration Death Master File. Survival rates were measured at 30, 90, and 180 days and 1 and 2 years from injury among two groups of trauma patients who survived to discharge: major trauma (Abbreviated Injury Scale score Q 3 injuries, n = 2,238) and minor trauma (Abbreviated Injury Scale score e 2 injuries, n = 1,171). Control groups matched to each trauma group by age and sex were simulated from the US general population using annual survival probabilities from census data. Kaplan-Meier and log-rank analyses conditional upon survival to each time point were used to determine changes in risk of mortality after discharge. Cox proportional hazards models with left truncation at the time of discharge were used to determine independent predictors of mortality after discharge. Results: The survival rate in trauma patients with major injuries was 92% at 30 days posttrauma and declined to 84% by 3 years (p 9 0.05 compared with general population). Minor trauma patients experienced a survival rate similar to the general population. Age and injury severity were the only independent predictor so f long-termmortality given survival to discharge. Log-ranktests conditional on survival to each time point showed that mortality risk in patients with major injuries remained significantly higher than the general population for up to 6 months after injury. Conclusion: Thesurvival rateoftrauma patientswithmajorinjuriesremainssignificantlylower thansurvival for minor traumapatientsand the general population for several months postdischarge. Surveillance for early identification and treatment of complications may be needed for trauma patients with major injuries.
KW - Acute injury
KW - Trauma Quality Improvement Program
KW - trauma survival
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UR - http://www.scopus.com/inward/citedby.url?scp=84865977706&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e318253b5db
DO - 10.1097/TA.0b013e318253b5db
M3 - Article
C2 - 22710768
AN - SCOPUS:84865977706
SN - 2163-0755
VL - 73
SP - 699
EP - 703
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 3
ER -