Long-term survival of adult trauma patients

Giana H. Davidson, Christian A. Hamlat, Frederick P. Rivara, Thomas D. Koepsell, Gregory Jurkovich, Saman Arbabi

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Context: Inpatient trauma case fatality rates may provide an incomplete assessment for overall trauma care effectiveness. To date, there have been few large studies evaluating long-term mortality in trauma patients and identifying predictors that increase risk for death following hospital discharge. Objectives: To determine the long-term mortality of patients following trauma admission and to evaluate survivorship in relationship with discharge disposition. Design, Setting, and Patients: Retrospective cohort study of 124 421 injured adult patients during January 1995 to December 2008 using the Washington State Trauma Registry linked to death certificate data. Main Outcome Measures: Kaplan-Meier and Cox proportional hazards models were used to evaluate long-term mortality following hospital admission for trauma. Results: Of the 124 421 trauma patients, 7243 died before hospital discharge and 21 045 died following hospital discharge. Cumulative mortality at 3 years postinjury was 16% (95% confidence interval [CI], 15.8%-16.2%) compared with the expected population cumulative mortality of 5.9% (95% CI, 5.9%-5.9%). In-hospital mortality improved during the 14-year study period from 8% (n=362) to 4.9% (n=600), whereas long-term cumulative mortality increased from 4.7% (95% CI, 4.1%-5.4%) to 7.4% (95% CI, 6.8%-8.1%). After adjustments for confounders, patients who were older and those who were discharged to a skilled nursing facility had the highest risk of death. The adjusted hazard ratios (HRs) for death after discharge to a skilled nursing facility compared with that after discharge home were 1.41 (95% CI, 0.72-2.76) for patients aged 18 to 30 years, 1.92 (95% CI, 1.36-2.73) for patients aged 31 to 45 years, 2.02 (95% CI, 1.39-2.93) for patients aged 46 to 55 years, 1.93 (95% CI, 1.40-2.64) for patients aged 56 to 65 years, 1.49 (95% CI, 1.14-1.94) for patients aged 66 to 75 years, 1.54 (95% CI, 1.27-1.87) for patients aged 76 to 80 years, and 1.38 (95% CI, 1.09-1.74) for patients older than 80 years. Other significant predictors of mortality after discharge included maximum head injury score on Abbreviated Injury Score scale (HR, 1.20; 95% CI, 1.13-1.26), Injury Severity Score (HR, 0.98; 95% CI, 0.97-0.98), Functional Independence Measure (HR, 0.89; 95% CI, 0.88-0.91), mechanism of injury being a fall (HR, 1.43; 95% CI, 1.30-1.58), and having Medicare (HR, 1.28; 95% CI, 1.15-1.43) or other government insurance (HR, 1.65; 95% CI, 1.47-1.85). Conclusions: Among adults admitted for trauma in Washington State, 3-year cumulative mortality was 16% despite a decline in in-hospital deaths. Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality.

Original languageEnglish (US)
Pages (from-to)1001-1007
Number of pages7
JournalJAMA - Journal of the American Medical Association
Volume305
Issue number10
DOIs
StatePublished - Mar 9 2011
Externally publishedYes

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Confidence Intervals
Survival
Wounds and Injuries
Mortality
Skilled Nursing Facilities
Hospital Mortality
Abbreviated Injury Scale
Injury Severity Score
Death Certificates
Medicare
Insurance
Craniocerebral Trauma
Proportional Hazards Models
Registries
Inpatients
Cohort Studies
Survival Rate
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Davidson, G. H., Hamlat, C. A., Rivara, F. P., Koepsell, T. D., Jurkovich, G., & Arbabi, S. (2011). Long-term survival of adult trauma patients. JAMA - Journal of the American Medical Association, 305(10), 1001-1007. https://doi.org/10.1001/jama.2011.259

Long-term survival of adult trauma patients. / Davidson, Giana H.; Hamlat, Christian A.; Rivara, Frederick P.; Koepsell, Thomas D.; Jurkovich, Gregory; Arbabi, Saman.

In: JAMA - Journal of the American Medical Association, Vol. 305, No. 10, 09.03.2011, p. 1001-1007.

Research output: Contribution to journalArticle

Davidson, GH, Hamlat, CA, Rivara, FP, Koepsell, TD, Jurkovich, G & Arbabi, S 2011, 'Long-term survival of adult trauma patients', JAMA - Journal of the American Medical Association, vol. 305, no. 10, pp. 1001-1007. https://doi.org/10.1001/jama.2011.259
Davidson, Giana H. ; Hamlat, Christian A. ; Rivara, Frederick P. ; Koepsell, Thomas D. ; Jurkovich, Gregory ; Arbabi, Saman. / Long-term survival of adult trauma patients. In: JAMA - Journal of the American Medical Association. 2011 ; Vol. 305, No. 10. pp. 1001-1007.
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abstract = "Context: Inpatient trauma case fatality rates may provide an incomplete assessment for overall trauma care effectiveness. To date, there have been few large studies evaluating long-term mortality in trauma patients and identifying predictors that increase risk for death following hospital discharge. Objectives: To determine the long-term mortality of patients following trauma admission and to evaluate survivorship in relationship with discharge disposition. Design, Setting, and Patients: Retrospective cohort study of 124 421 injured adult patients during January 1995 to December 2008 using the Washington State Trauma Registry linked to death certificate data. Main Outcome Measures: Kaplan-Meier and Cox proportional hazards models were used to evaluate long-term mortality following hospital admission for trauma. Results: Of the 124 421 trauma patients, 7243 died before hospital discharge and 21 045 died following hospital discharge. Cumulative mortality at 3 years postinjury was 16{\%} (95{\%} confidence interval [CI], 15.8{\%}-16.2{\%}) compared with the expected population cumulative mortality of 5.9{\%} (95{\%} CI, 5.9{\%}-5.9{\%}). In-hospital mortality improved during the 14-year study period from 8{\%} (n=362) to 4.9{\%} (n=600), whereas long-term cumulative mortality increased from 4.7{\%} (95{\%} CI, 4.1{\%}-5.4{\%}) to 7.4{\%} (95{\%} CI, 6.8{\%}-8.1{\%}). After adjustments for confounders, patients who were older and those who were discharged to a skilled nursing facility had the highest risk of death. The adjusted hazard ratios (HRs) for death after discharge to a skilled nursing facility compared with that after discharge home were 1.41 (95{\%} CI, 0.72-2.76) for patients aged 18 to 30 years, 1.92 (95{\%} CI, 1.36-2.73) for patients aged 31 to 45 years, 2.02 (95{\%} CI, 1.39-2.93) for patients aged 46 to 55 years, 1.93 (95{\%} CI, 1.40-2.64) for patients aged 56 to 65 years, 1.49 (95{\%} CI, 1.14-1.94) for patients aged 66 to 75 years, 1.54 (95{\%} CI, 1.27-1.87) for patients aged 76 to 80 years, and 1.38 (95{\%} CI, 1.09-1.74) for patients older than 80 years. Other significant predictors of mortality after discharge included maximum head injury score on Abbreviated Injury Score scale (HR, 1.20; 95{\%} CI, 1.13-1.26), Injury Severity Score (HR, 0.98; 95{\%} CI, 0.97-0.98), Functional Independence Measure (HR, 0.89; 95{\%} CI, 0.88-0.91), mechanism of injury being a fall (HR, 1.43; 95{\%} CI, 1.30-1.58), and having Medicare (HR, 1.28; 95{\%} CI, 1.15-1.43) or other government insurance (HR, 1.65; 95{\%} CI, 1.47-1.85). Conclusions: Among adults admitted for trauma in Washington State, 3-year cumulative mortality was 16{\%} despite a decline in in-hospital deaths. Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality.",
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T1 - Long-term survival of adult trauma patients

AU - Davidson, Giana H.

AU - Hamlat, Christian A.

AU - Rivara, Frederick P.

AU - Koepsell, Thomas D.

AU - Jurkovich, Gregory

AU - Arbabi, Saman

PY - 2011/3/9

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N2 - Context: Inpatient trauma case fatality rates may provide an incomplete assessment for overall trauma care effectiveness. To date, there have been few large studies evaluating long-term mortality in trauma patients and identifying predictors that increase risk for death following hospital discharge. Objectives: To determine the long-term mortality of patients following trauma admission and to evaluate survivorship in relationship with discharge disposition. Design, Setting, and Patients: Retrospective cohort study of 124 421 injured adult patients during January 1995 to December 2008 using the Washington State Trauma Registry linked to death certificate data. Main Outcome Measures: Kaplan-Meier and Cox proportional hazards models were used to evaluate long-term mortality following hospital admission for trauma. Results: Of the 124 421 trauma patients, 7243 died before hospital discharge and 21 045 died following hospital discharge. Cumulative mortality at 3 years postinjury was 16% (95% confidence interval [CI], 15.8%-16.2%) compared with the expected population cumulative mortality of 5.9% (95% CI, 5.9%-5.9%). In-hospital mortality improved during the 14-year study period from 8% (n=362) to 4.9% (n=600), whereas long-term cumulative mortality increased from 4.7% (95% CI, 4.1%-5.4%) to 7.4% (95% CI, 6.8%-8.1%). After adjustments for confounders, patients who were older and those who were discharged to a skilled nursing facility had the highest risk of death. The adjusted hazard ratios (HRs) for death after discharge to a skilled nursing facility compared with that after discharge home were 1.41 (95% CI, 0.72-2.76) for patients aged 18 to 30 years, 1.92 (95% CI, 1.36-2.73) for patients aged 31 to 45 years, 2.02 (95% CI, 1.39-2.93) for patients aged 46 to 55 years, 1.93 (95% CI, 1.40-2.64) for patients aged 56 to 65 years, 1.49 (95% CI, 1.14-1.94) for patients aged 66 to 75 years, 1.54 (95% CI, 1.27-1.87) for patients aged 76 to 80 years, and 1.38 (95% CI, 1.09-1.74) for patients older than 80 years. Other significant predictors of mortality after discharge included maximum head injury score on Abbreviated Injury Score scale (HR, 1.20; 95% CI, 1.13-1.26), Injury Severity Score (HR, 0.98; 95% CI, 0.97-0.98), Functional Independence Measure (HR, 0.89; 95% CI, 0.88-0.91), mechanism of injury being a fall (HR, 1.43; 95% CI, 1.30-1.58), and having Medicare (HR, 1.28; 95% CI, 1.15-1.43) or other government insurance (HR, 1.65; 95% CI, 1.47-1.85). Conclusions: Among adults admitted for trauma in Washington State, 3-year cumulative mortality was 16% despite a decline in in-hospital deaths. Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality.

AB - Context: Inpatient trauma case fatality rates may provide an incomplete assessment for overall trauma care effectiveness. To date, there have been few large studies evaluating long-term mortality in trauma patients and identifying predictors that increase risk for death following hospital discharge. Objectives: To determine the long-term mortality of patients following trauma admission and to evaluate survivorship in relationship with discharge disposition. Design, Setting, and Patients: Retrospective cohort study of 124 421 injured adult patients during January 1995 to December 2008 using the Washington State Trauma Registry linked to death certificate data. Main Outcome Measures: Kaplan-Meier and Cox proportional hazards models were used to evaluate long-term mortality following hospital admission for trauma. Results: Of the 124 421 trauma patients, 7243 died before hospital discharge and 21 045 died following hospital discharge. Cumulative mortality at 3 years postinjury was 16% (95% confidence interval [CI], 15.8%-16.2%) compared with the expected population cumulative mortality of 5.9% (95% CI, 5.9%-5.9%). In-hospital mortality improved during the 14-year study period from 8% (n=362) to 4.9% (n=600), whereas long-term cumulative mortality increased from 4.7% (95% CI, 4.1%-5.4%) to 7.4% (95% CI, 6.8%-8.1%). After adjustments for confounders, patients who were older and those who were discharged to a skilled nursing facility had the highest risk of death. The adjusted hazard ratios (HRs) for death after discharge to a skilled nursing facility compared with that after discharge home were 1.41 (95% CI, 0.72-2.76) for patients aged 18 to 30 years, 1.92 (95% CI, 1.36-2.73) for patients aged 31 to 45 years, 2.02 (95% CI, 1.39-2.93) for patients aged 46 to 55 years, 1.93 (95% CI, 1.40-2.64) for patients aged 56 to 65 years, 1.49 (95% CI, 1.14-1.94) for patients aged 66 to 75 years, 1.54 (95% CI, 1.27-1.87) for patients aged 76 to 80 years, and 1.38 (95% CI, 1.09-1.74) for patients older than 80 years. Other significant predictors of mortality after discharge included maximum head injury score on Abbreviated Injury Score scale (HR, 1.20; 95% CI, 1.13-1.26), Injury Severity Score (HR, 0.98; 95% CI, 0.97-0.98), Functional Independence Measure (HR, 0.89; 95% CI, 0.88-0.91), mechanism of injury being a fall (HR, 1.43; 95% CI, 1.30-1.58), and having Medicare (HR, 1.28; 95% CI, 1.15-1.43) or other government insurance (HR, 1.65; 95% CI, 1.47-1.85). Conclusions: Among adults admitted for trauma in Washington State, 3-year cumulative mortality was 16% despite a decline in in-hospital deaths. Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality.

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