Chronic consequences of acute injuries: worse survival after discharge.
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 ≥ 3 injuries, n = 2,238) and minor trauma (Abbreviated Injury Scale score ≤ 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 > 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 predictors of long-term mortality given survival to discharge. Log-rank tests 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.


CONCLUSIONS
The survival rate of trauma patients with major injuries remains significantly lower than survival for minor trauma patients and the general population for several months postdischarge. Surveillance for early identification and treatment of complications may be needed for trauma patients with major injuries.


METHODS
Prognostic study, level III.
Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas 76051, USA. shahid.shafi@baylorhealth.edu
Shahid
S
Shafi
Lindsay A
LA
Renfro
Sunni
S
Barnes
Nadine
N
Rayan
Larry M
LM
Gentilello
Neil
N
Fleming
David
D
Ballard
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010351:Patient Discharge / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011787:Quality of Health Care; D012042:Registries; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States; D014505:Urban Population; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D055815:Young Adult