title: Acute and long-term outcomes of extremely injured blunt trauma victims.
abstract: Long-term outcomes after blunt trauma remain poorly defined. The purpose of this study was to document such outcomes in extremely injured adults (Injury Severity Score > or = 50). From April 1990 to June 1993, 76 patients (5% of all trauma victims) had an ISS > or = 50 at a single trauma center. Thirty-five (46%) survived to hospital discharge. The mean duration of hospital stay was longer for survivors than for nonsurvivors (92 days versus 16 days, p < 0.001). Of the 35 survivors, 26% were discharged directly home, 60% to a rehabilitation hospital, 8% to a chronic care facility, and 6% to an acute care hospital. After a mean follow-up of 27 months, 6% had died, 9% refused participation, and the remaining 30 patients (91% of long-term survivors) demonstrated significant residual disabilities in physical, emotional, and mental health status. We suggest that extremely injured patients comprise a small proportion of blunt trauma victims, consume substantial acute care hospital resources, often survive, and yet frequently have residual disability. A reduction in this long-term disability may represent the greatest challenge in modern trauma care.
authors.affiliation: Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
authors.forename: F D
authors.initials: FD
authors.lastname: Brenneman
authors.forename: B R
authors.initials: BR
authors.lastname: Boulanger
authors.forename: B A
authors.initials: BA
authors.lastname: McLellan
authors.forename: J P
authors.initials: JP
authors.lastname: Culhane
authors.forename: D A
authors.initials: DA
authors.lastname: Redelmeier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006304:Health Status; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012042:Registries; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy