title: Trauma patients who present in a delayed fashion: a unique and challenging population.
abstract: A proportion of trauma patients present for evaluation in a delayed fashion after injury, likely due to a variety of medical and nonmedical reasons. There has been little investigation into the characteristics and outcomes of trauma patients who present delayed. We hypothesize that trauma patients who present in a delayed fashion are a unique population at risk of increased trauma-related complications.
  
  
  
  This was a retrospective review from 2010-2015 at a Level I trauma center. Patients were termed delayed if they presented >24 hours after injury. Patients admitted within 24 hours of their injury were the comparison group. Charts were reviewed for demographics, mechanism, comorbidities, complications and outcomes. A subgroup analysis was done on patients who suffered falls.
  
  
  
  During the 5-y period, 11,705 patients were admitted. A total of 588 patients (5%) presented >24 h after their injury. Patients in the delayed group were older (65 versus 55 y, P < 0.001) and more likely to have psychiatric comorbidities (33% vs. 24%, P = 0.0001) than the control group. They were also more likely to suffer substance withdrawal (8.9% vs. 4.1%, P < 0.001) but had toxicology testing for drugs and alcohol done at significantly lower rates. Patients that presented delayed after falls were similar in age and injury severity score (ISS) but more likely to suffer substance withdrawal when compared to those with falls that presented within 24 hours. Patients with falls that presented delayed had toxicology testing at significantly lower rates than the comparison group.
  
  
  
  Trauma patients that present to the hospital in a delayed fashion have unique characteristics and are more likely to suffer negative outcomes including substance withdrawal. Future goals will include exploring strategies for early intervention, such as automatic withdrawal monitoring and social work referral for all patients who present in a delayed fashion.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Kao
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Hector
authors.initials: H
authors.lastname: Nunez
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Sean F
authors.initials: SF
authors.lastname: Monaghan
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Daithi S
authors.initials: DS
authors.lastname: Heffernan
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Adams
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Lueckel
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island. Electronic address: andrew_stephen@brown.edu.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Stephen
mesh_terms: D000368:Aged; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D013997:Time Factors; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: Delayed presentation; Elderly; Injury; Trauma; Withdrawal