Moving Beyond Traditional Measurement of Mortality after Injury: Evaluation of Risks for Late Death

BACKGROUND: The purpose of this study was to evaluate long-term mortality after trauma, and to determine risk factors and possible disparities related to mortality after hospital discharge. STUDY DESIGN: Level I trauma center registry data from a 6-year period (2000 through 2005) were linked to patient electronic medical records, the National Death Index with cause of death codes, and census data using geographic information science (GIS) methodologies. Census data provided supplemental demographic and socioeconomic information from patient neighborhoods. RESULTS: The hospital mortality rate for 15,285 patients was 3.3%, and mortality after discharge was 4.8%. Overall mortality for the study period was 8.1% (average follow-up, 2.8 years, 1-year mortality, 5.4%). Mortality after discharge was related to the initial injury in 33%, possibly related in 23%, and unrelated in 44% of patients. Logistic regression analysis demonstrated that independent predictors of hospital mortality were age, Injury Severity Score, gunshot injury, significant head injury, fall, and spinal cord injury. In contrast, independent risk factors for mortality after discharge were age, hospital length of stay, discharge from the hospital to a locale other than home, and the presence of spinal cord injury. Intoxication at hospital admission and injury due to a gunshot wound or motor vehicle collision were protective for late mortality. Bivariate analysis of census data demonstrated that lower socioeconomic status was associated with improved hospital survival, and non-native status was associated with mortality after discharge. CONCLUSIONS: There is significant mortality attributable to trauma for up to 1 year after hospital discharge. These findings suggest that mortality after trauma needs to be measured beyond hospital discharge in order to assess the complete impact of injury. (J Am Coll Surg 2010;210:788-796. (C) 2010 Published by Elsevier Inc. on behalf of the American College of Surgeons)