Mortality of severely injured patients after ICU discharge: An underestimated problem?

Abstract

BackgroundMost trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as “failure to rescue” of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards.MethodsRetrospective analysis of the TraumaRegister DGU® with data from 2015-2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 hours but died later on.ResultsA total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6,576 patients (8.0%) died during their hospital stay. Out of those, 5,481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay.Conclusions17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may represent patients that died of potentially avoidable or treatable complications.