1 in 3 Trauma Patients Discharged to Nursing Homes Die Within Three Years

Cheryl Clark, for HealthLeaders Media , March 9, 2011

The authors also suggest that to improve care for trauma patients after hospital discharge, a much longer period than the standard 30-day mortality measure should be used. "We may be seeing a downwind shift in mortality from improvements in the acute care period," they wrote.

The study is published in the March 8 edition of the Journal of the American Medical Association.

In-hospital deaths for these trauma patients actually declined during the 13-year study period. But after discharge, mortality rates rose, suggesting that there may be improvements in trauma care but not in care after acute hospitalization.

"These results suggest that in an adult trauma patient, acute injury is not just a brief psychological setback to a healthy life, but rather signals significant long-term mortality in a large number of patients," they wrote.

In their study, 7,243 of the 124,421 trauma patients died during their trauma hospitalization, but 21,045 died within three years after discharge. Compared with a 34% mortality rate for those discharged to a skilled nursing facility, those discharged home without assistance had a 4% mortality rate by year three, those who went home with assistance, 15.9%; and those discharged to a rehabilitation facility had a 12% rate of death.

Also strongly predictive of death in the first year after discharge was age, systolic blood pressure less than 90 mm Hg, those with a Glasgow Coma Scale score of less than 9, male sex, and a mechanism of fall or blunt injury.

The authors noted that Washington State has five levels of hospital trauma designation, and all were included in the study.

Comments are moderated. Please be patient.

4 comments on "Trauma Patient Mortality Soars After Discharge"

A Nursing Perspective (3/9/2011 at 9:41 PM)
Having worked in level II trauma as a bedside RN in ICU and, later, as a discharge planner, this information as presented seems to reflect a ridiculous study that must have some type of ulterior [$] motive for that particular spin. The majority, if not all, of trauma patients who are so damaged that they require long term custodial SNF care of greater than 3 years are the severely brain injured patients who are unable to interact with their environment, are on tube feedings and long term trach care that can almost never be managed in the home. They are very high risk for mortality and are already under the umbrella of significant morbidity.

Tim Tarpey (3/9/2011 at 10:41 AM)
I supspect that mortality rates for those who enter the trauma center are greater than those who enter the walk-in clinic at the same hospital. Does that mean that the trauma center provides a lower quality of care than the walk-in clinic? And I suspect that patients discharged from a trauma center to an assisted living facility, to a home health agency, or any other level of care have a higher mortality rate than those who enter that same level of care without the trauma.

Laurie Hilyard RN, MSN (3/9/2011 at 9:43 AM)
Did it occur to anyone that those discharged to a skilled nursing facility are more physically compromised than those discharged to lesser care? Unless discharge destinations were randomized, comparing survival rates at a SNF to survival rates in less intense care settings is comparing apples to rocks.




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