Long-term mortality outcome of victims of major trauma.
BACKGROUND
Although trauma is associated with major acute morbidity and mortality, its long-term outcome is less well defined. We sought to define the rate of readmission to hospital and long-term mortality of victims of major trauma.


METHODS
All Calgary Health Region residents presenting to the regional trauma program with an injury severity score (ISS) > or = 12 between April 1, 2002 and March 31, 2006 were included. Readmission to hospital within one-year and deaths occurring on or before September 30, 2008 were identified using regional and provincial databases.


RESULTS
A total of 2652 incident major trauma episodes occurred among 2630 residents; the median age was 41.3 [interquartile range (IQR); 23.1-59.2] years, 1,915 (72%) were male, the median ISS was 19 (IQR; 16-25), and 717 (27%) required intensive care unit admission. Among 2350 survivors to hospital discharge, 537 readmissions occurred (median length of stay 4.0; IQR; 1.6-7.5 days) among 386 patients within one-year of the incident trauma episode, and 323 (60%) required surgery. Re-admitted patients were older, had higher ISS, had longer initial admission length of stay, and were less likely to have sports related injuries. Two hundred and fifteen (8%) of 2350 survivors to hospital discharge died during the median study follow-up duration of 1543 (IQR; 1181-1934) days. Case-fatality rates for 28 days, 90 days, and 365 days were 304 (11%), 327 (12%), and 370 (14%), respectively. Among survivors to 28 days (n=2348), 66 (3%) suffered delayed one-year mortality (i.e. death occurred between 28 days and 365 days post-trauma). Age > or = 65 years of age, initial hospitalisation for > or = 28 days, and unintentional falls were independently associated with delayed one-year mortality.


CONCLUSIONS
Patients with major trauma are at risk for both acute and delayed adverse outcomes.
Laupland
Kevin B
KB
Department of Medicine, University of Calgary and Calgary Health Region, Calgary, Alberta, Canada. Kevin.laupland@calgaryhealthregion.ca
Svenson
Lawrence W
LW
Grant
Vincent
V
Ball
Chad G
CG
Mercado
Michelle
M
Kirkpatrick
Andrew W
AW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012041:Regional Medical Programs / Q000706:statistics & numerical data; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult