Age strongly
predicted risk of death as did discharge to a skilled nursing facility;
Medicare on risk list, too.
March 8, 2011
The headline from the new study of 120,000 adult trauma patients is that
16 percent died within 3 years of their injury with no injury the
expected mortality would be about 6 percent. But the study also notes
some key factors, including being a senior citizens, that increase this
risk of death following a trauma injury.
The researchers
also found that trauma patients who were discharged to a skilled nursing
facility had a significantly increased risk of death compared with
patients discharged home without assistance.
A factor may
certainly have been that those discharged to skilled nursing facilities
tended to be much older than the average. From all patients studied,
24.7% were discharged to a skilled nursing facility, but among those
older than age 65 years, 54% were discharged to a skilled nursing
facility. Patients who were older and those who were discharged to a
skilled nursing facility had the highest risk of death
Age, the
researchers acknowledged, strongly predicted risk of death during the
follow-up period and time to death following injury.
The study will
be in the March 9 issue of the Journal of the American Medical
Association (JAMA).
Trauma can lead
to significant illness or death. "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," according to background information in the article.
"Information on
the short- and long-term causes of death following discharge for injury
could potentially identify gaps in care amenable to improvement, and
allow for counseling of patients and their families about prognosis
following traumatic injuries."
Giana H.
Davidson, M.D., M.P.H., of the Harborview Injury Prevention and Research
Center, Seattle, and colleagues conducted a study to examine the
long-term mortality of Washington State trauma patients and to identify
risk factors for death following hospital discharge. The study included
124,421 injured adult patients, from January 1995 to December 2008, and
used the Washington State Trauma Registry linked to death certificate
data. The average age of the patients was 53 years; 59 percent were
male.
Of the patients
in the study,
● 7,243 died (5.8 percent) during their trauma hospitalization;
● 21,045 died following hospital discharge.
The proportion
of patients who died while in the hospital declined each year of the
study, from 8 percent in 1995 to approximately 4.9 percent in 2008,
whereas long-term cumulative mortality increased from 4.7 percent to 7.4
percent.
Analysis
indicated that cumulative mortality following injury was 9.8 percent at
1 year and 16 percent at 3 years.
Age strongly
predicted risk of death during the follow-up period and time to death
following injury.
The significant
predictors of mortality after discharge included -
● maximum head injury score on Abbreviated Injury Score scale,
● Injury Severity Score,
● Functional Independence Measure,
● mechanism of injury being a fall, and
● having Medicare or
● having other government insurance
Among patients
discharged from the hospital, more than half were discharged home
without assistance and nearly one-quarter were discharged to a skilled
nursing facility.
"Overall,
cumulative mortality was significantly lower for those patients
discharged home with or without assistance and patients discharged to
rehabilitation facilities than for patients discharged to a skilled
nursing facility, who had a 34 percent cumulative mortality by 3 years
postdischarge," the authors write.
"... our results
indicate that skilled nursing facility discharge status may at least be
a marker for significantly higher risk of subsequent mortality and may
be the focus for future research and intervention, especially in the age
group of 31- to 80-year-olds.
There are
significant differences in physical therapy and occupational therapy for
patients in rehabilitation programs compared with patients at skilled
nursing facilities, even when comparing similar demographic
characteristics and medical complexity."
The researchers
add that future research in surgical patients should focus on outcomes
longer than the standard reporting of 30-day mortality because a
downwind shift in mortality may be occurring from improvements in the
acute care period.
"Interventions
should be aimed at improving the care of the injured patient following
discharge from the hospital and narrow the gap in outcomes for those
patients discharged to skilled nursing facilities," they write.
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