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Trauma patients have high death rate in years after injury–Harborview study

March 8, 2011 | By LocalHealthGuide More

Roughly one in seven patients hospitalized for severe trauma in Washington State dies in the following three years, according to a new study by researchers in Seattle.

The findings suggest that despite strides made in pre-hospital and in-hospital trauma care, little progress has been made in improving the long-term survival of trauma patients, said study’s lead investigator Dr. Saman Arbabi, head of the Acute Care Section of the Harborview Injury Prevention & Research Center.

In the study, Dr. Arbabi and his colleagues examined the medical records of more than 124,000 patients who were treated at one of state’s 78 certified trauma hospitals from 1995 to 2008.

The researchers found that the percentage of trauma patients dying before reaching the hospital or while in the hospital had dropped by almost half, from 8 percent in 1995 to between 4-5 percent 14 years later.

Such an improvement over so short of time was “impressive,” Dr. Arbabi said.

But the researchers also found that after discharge a disturbingly high number did not survive long, with 10 percent dying within one year and 16 percent at three.

“The medics are doing a good job: they’re keeping them alive. We’re doing a good job in the hospital: keeping them alive,” Dr. Arbabi said. “… but many of the people we’ve worked so hard to keep alive in the hospital are dying after discharge.”

No previous study has looked at long-term survival rate for a large trauma system like Washington State’s, Dr. Arbabi said.

In general, patients who were healthy enough to be discharged to home tended to do well, said Dr. Arbabi.

Those who were discharged to a rehabilitation facility tended to do worse, but not significantly so when age, severity of injury and other factors taken into account, he said.

But patients who were discharged to a skilled nursing facility were at very high risk of dying, particularly those aged 45 to 75 years, whose risk of dying was about twice that of those who had been discharged home.

Indeed, at the end of three years, one in three of patients discharged to a skilled nursing facility had died.

The findings do not necessarily indicate that the skilled nursing facilities are doing anything wrong, Dr. Arbabi said. “The fact is that the patients who go to skilled nursing facilities are our sickest patients. But the findings say that if we are going to make a difference, if we want to improve the long-term outcome of trauma patients, the group to focus on are those patients who go to skilled nursing facilities.”

Strategies that might help improve their chances of survival might include keeping them in the hospital longer, giving them physical therapy and get them started on rehabilitation programs, and providing closer medical supervision after discharge, Dr. Arbabi said.

Dr. Giana Davidson was the lead author of the paper, which appears in this week’s issue of JAMA, the Journal of the American Medical Association. The team include researchers from the University of Washington’s Departments of Surgery, Pediatrics and Epidemiology as well as the Harborview Center.

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