Heena P Santry1, Charles M Psoinos2, Christopher J Wilbert3, Julie M Flahive2, Aimee R Kroll-Desrosiers4, Timothy A Emhoff2, Catarina I Kiefe4. 1. Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: heena.santry@umassmemorial.org. 2. Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA. 3. Department of Emergency Medicine, MedStar Harbor Hospital, Baltimore, MD, USA. 4. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Abstract
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
Entities:
Keywords:
Critical injury; Goals of care; Injury mortality; Trauma mortality
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