Post-Hospitalization Mortality High in Trauma Patients

Discharge to skilled nursing facility is a strong predictor of mortality

TUESDAY, March 8 (HealthDay News) -- The three-year cumulative mortality rate for trauma patients after being discharged from Washington state hospitals is relatively high, particularly in those discharged to skilled nursing facilities, according to research published in the March 9 issue of the Journal of the American Medical Association.

Giana H. Davidson, M.D., M.P.H., of the Harborview Injury Prevention and Research Center in Seattle, and colleagues studied data on 124,421 adult trauma patients admitted between 1995 and 2008 in Washington state to ascertain the long-term mortality of trauma patients after admission and identify predictors for increased risk of death after discharge.

The researchers found that, prior to discharge, 7,243 patients died, and after discharge, 21,045 died, with a cumulative three-year mortality of 16 percent (versus the expected population cumulative mortality of 5.9 percent). Over the study period, in-hospital mortality improved from 8 to 4.9 percent, but long-term cumulative mortality rose from 4.7 to 7.4 percent. The highest risk of death was found in patients with greater age and those discharged to a skilled nursing facility. Other predictors of post-discharge mortality included maximum head injury score on Abbreviated Injury Score scale, Injury Severity Score, Functional Independence Measure, mechanism of injury being a fall, and having Medicare or another form of government insurance.

"Among adults admitted for trauma in Washington State, three-year cumulative mortality was 16 percent despite a decline in in-hospital deaths. Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality," the authors write.

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