Chronic consequences of acute injuries: Worse survival after discharge

Shahid Shafi, Lindsay A. Renfro, Sunni Barnes, Nadine Rayan, Larry M. Gentilello, Neil Fleming, David Ballard

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: The Trauma Quality Improvement Program uses inhospital mortality to measure quality of care, which assumes patients who survive injury are not likely to suffer higher mortality after discharge. We hypothesized that survival rates in trauma patients who survive to discharge remain stable afterward. Methods: Patients treated at an urban Level I trauma center (2006-2008) were linked with the Social Security Administration Death Master File. Survival rates were measured at 30, 90, and 180 days and 1 and 2 years from injury among two groups of trauma patients who survived to discharge: major trauma (Abbreviated Injury Scale score Q 3 injuries, n = 2,238) and minor trauma (Abbreviated Injury Scale score e 2 injuries, n = 1,171). Control groups matched to each trauma group by age and sex were simulated from the US general population using annual survival probabilities from census data. Kaplan-Meier and log-rank analyses conditional upon survival to each time point were used to determine changes in risk of mortality after discharge. Cox proportional hazards models with left truncation at the time of discharge were used to determine independent predictors of mortality after discharge. Results: The survival rate in trauma patients with major injuries was 92% at 30 days posttrauma and declined to 84% by 3 years (p 9 0.05 compared with general population). Minor trauma patients experienced a survival rate similar to the general population. Age and injury severity were the only independent predictor so f long-termmortality given survival to discharge. Log-ranktests conditional on survival to each time point showed that mortality risk in patients with major injuries remained significantly higher than the general population for up to 6 months after injury. Conclusion: Thesurvival rateoftrauma patientswithmajorinjuriesremainssignificantlylower thansurvival for minor traumapatientsand the general population for several months postdischarge. Surveillance for early identification and treatment of complications may be needed for trauma patients with major injuries.

Original languageEnglish (US)
Pages (from-to)699-703
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Issue number3
StatePublished - Sep 2012


  • Acute injury
  • Trauma Quality Improvement Program
  • trauma survival

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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