Abstract
BackgroundSurvivors of trauma are at increased risk of dying after discharge. Studies have found that age, head injury, injury severity, falls and co-morbidities predict long-term mortality. The objective of our study was to build a nomogram predictor of 1-year and 3-year mortality for major blunt trauma adult survivors of the index hospitalization.MethodsUsing data from the Singapore National Trauma Registry, 2011–2013, we analyzed adults aged 18 and over, admitted after blunt injury, with an injury severity score (ISS) of 12 or more, who survived the index hospitalization, linked to death registry data. The study population was randomly divided 60/40 into separate construction and validation datasets, with the model built in the construction dataset, then tested in the validation dataset. Multivariable logistic regression was used to analyze 1-year and 3-year mortality.ResultsOf the 3414 blunt trauma survivors, 247 (7.2%) died within 1 year, and 551 (16.1%) died within 3 years of injury. Age (OR 1.06, 95% CI 1.05–1.07, p < 0.001), male gender (OR 1.53, 95% CI 1.12–2.10, p < 0.01), low fall from 0.5 m or less (OR 3.48, 95% CI 2.06–5.87, p < 0.001), Charlson comorbidity index of 2 or more (OR 2.26, 95% CI 1.38–3.70, p < 0.01), diabetes (OR 1.31, 95% CI 1.68–2.52, p = 0.04), cancer (OR 1.76, 95% CI 0.94–3.32, p = 0.08), head and neck AIS 3 or more (OR 1.79, 95% CI 1.13–2.84, p = 0.01), length of hospitalization of 30 days or more (OR 1.99, 95% CI 1.02–3.86, p = 0.04) were predictors of 1-year mortality. This model had a c-statistic of 0.85. Similar factors were found significant for the model predictor of 3-year mortality, which had a c-statistic of 0.83. Both models were validated on the second dataset, with an overall accuracy of 0.94 and 0.84 for 1-year and 3-year mortality respectively.ConclusionsAdult survivors of major blunt trauma can be risk-stratified at discharge for long-term support.
Highlights
Survivors of trauma are at increased risk of dying after discharge
The demographic and clinical characteristics of the subjects in the derivation and validation samples were similar on all characteristics, except there was an insignificant difference in proportion of patients with a face AIS score of 3 or more, likely due to the overall low incidence of this type of injury
The following factors reduced the likelihood of 1-year mortality in univariate analysis: male gender, polytrauma, AIS of 3 or more for the thorax, abdomen and extremity regions, all high-velocity mechanisms of injury, undergoing an orthopedic operation, and receiving a blood transfusion (Table 2)
Summary
Survivors of trauma are at increased risk of dying after discharge. Studies have found that age, head injury, injury severity, falls and co-morbidities predict long-term mortality. The objective of our study was to build a nomogram predictor of 1-year and 3-year mortality for major blunt trauma adult survivors of the index hospitalization. Long-term mortality for survivors of trauma is an important indicator of the societal impact of trauma, as survivors of the index hospitalization have an increased risk of dying in the post-discharge period [1,2,3,4,5,6]. For adult blunt trauma patients sustaining major injury, and who survived the index hospitalization, different risk factors would contribute differentially to 1-year and 3-year mortality, and that patients with multiple risk factors would be at higher risk than patients with single risk factors. We examined the location and certified causes of death for these patients
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