Quadrimodal distribution of death after trauma suggests that critical injury is a potentially terminal disease
Department of Surgery; Department of Quantitative Health Sciences
Critical Care | Epidemiology | Health Services Research | Surgery | Trauma
BACKGROUND: Patterns of death after trauma are changing due to advances in critical care. We examined mortality in critically injured patients who survived index hospitalization.
METHODS: Retrospective analysis of adults admitted to a Level-1 trauma center (1/1/2000-12/31/2010) with critical injury was conducted comparing patient characteristics, injury, and resource utilization between those who died during follow-up and survivors.
RESULTS: Of 1,695 critically injured patients, 1,135 (67.0%) were discharged alive. As of 5/1/2012, 977/1,135 (86.0%) remained alive; 75/158 (47.5%) patients who died during follow-up, died in the first year. Patients who died had longer hospital stays (24 vs. 17 days) and ICU LOS (17 vs. 8 days), were more likely to undergo tracheostomies (36% vs. 16%) and gastrostomies (39% vs. 16%) and to be discharged to rehabilitation (76% vs. 63%) or skilled nursing (13% vs. 5.8%) facilities than survivors. In multivariable models, male sex, older age, and longer ICU LOS predicted mortality. Patients with ICU LOS >16 days had 1.66 odds of 1-year mortality vs. those with shorter ICU stays.
CONCLUSIONS: ICU LOS during index hospitalization is associated with post-discharge mortality. Patients with prolonged ICU stays after surviving critical injury may benefit from detailed discussions about goals of care after discharge.
DOI of Published Version
J Crit Care. 2015 Jun;30(3):656.e1-7. doi: 10.1016/j.jcrc.2015.01.003. Epub 2015 Jan 8. [Epub ahead of print] Link to article on publisher's site
Journal of critical care
Santry H, Psoinos CM, Wilbert CJ, Flahive J, Kroll A, Emhoff TA, Kiefe CI. (2015). Quadrimodal distribution of death after trauma suggests that critical injury is a potentially terminal disease. Population and Quantitative Health Sciences Publications. https://doi.org/10.1016/j.jcrc.2015.01.003. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1138