Short-term versus long-term trauma mortality: A systematic review

Abstract

BACKGROUND Trauma is the leading cause of death in the United States for persons under 44 years and the fourth leading cause of death in the elderly. Advancements in clinical care and standardization of treatment protocols have reduced 30-day trauma mortality to less than 4%. However, these improvements do not seem to correlate with long-term outcomes. Some reports have shown a greater than 20% mortality rate when looking at long-term outcomes. The aim of this study was to systematically review the incongruence between short- and long-term mortality for trauma patients. METHODS For this systematic review, we searched the Cochrane Library, EMBASE, Ovid Medline, Google Scholar, and Web of Science database to obtain relevant English, German, French, and Portuguese articles from 1965 to 2018. RESULTS Trauma patients have decreased long-term survival when compared to the general population and when compared with age-matched cohorts. Postdischarge trauma mortality is significantly higher (mean, 4.6% at 3–6 months, 15.8% at 2–3 years, 26.3% at 5–25 years) compared with controls (mean, 1.3%, 2.2%, and 15.6%, respectively). Patient comorbidities likely contribute to long-term trauma deaths. Trauma patients discharged to a skilled nursing facility have worse mortality compared with those discharged either to home or a rehabilitation center. In contrast to data available which illustrate that short-term mortality has improved, quality of evidence was not sufficient to determine if any improvements in long-term trauma mortality outcomes have also occurred. CONCLUSIONS The decreased short-term mortality observed in trauma patients does not appear correlated with decreased long-term mortality. The extent to which increased long-term trauma mortality is related to the initial traumatic insult—versus rising population age and comorbidity burden as well as suboptimal discharge location—requires further study. LEVEL OF EVIDENCE Systematic Review, level IV.

Causes of death following discharge after trauma in North Carolina

“…Among all ages, an increased risk of mortality has been shown to persist up to 3 years after a trauma hospitalization, 2,27 although Probst et al 3 proposed that this risk may hold for up to two decades after injury. Our estimate of 1-year mortality after trauma discharge (7.4%) is slightly lower than many published mortality rates, 16,[27][28][29][30] likely due to underestimating deaths not captured by NC death records and incomplete linkage to death certificates. While the number of deaths in the youngest patients was only 3.5% of the deaths in PTP, this still suggests that trauma is a life-altering event, regardless of age.…”

“…Across all periods, we found a higher odds of mortality for those discharged to a SNF, which is consistent with prior research showing SNF disposition to predict longterm mortality after trauma. 16,30,31 However, the impact of disposition appears to be an immediate effect, as early death was more common out of those discharged to a SNF. We recognize that patients discharging to a SNF may have inherently more risk for posthospital complications and death, and this disposition may reflect this population's low health resiliency and access to other rehab services.…”

Inflammation, Thrombosis, and Destruction: The Three-Headed Cerberus of Trauma- and SARS-CoV-2-Induced ARDS

“…Trauma is the leading cause of mortality among young people (aged 1-44 years) (1). It was estimated that the annual global mortality rate from trauma is more than five million (2).…”

Exploratory Investigation of the Plasma Proteome Associated with the Endotheliopathy of Trauma

“…The economic burden generated by trauma exceeds 189 billion dollars annually [ 2 ]. While there have been some advancements in the mitigation of early mortality in traumatic injury, progress has proven to be more difficult in improving long-term survival [ 3 ].…”