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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2018

Open Access 01-12-2018 | Original research

One-year and three-year mortality prediction in adult major blunt trauma survivors: a National Retrospective Cohort Analysis

Authors: Ting Hway Wong, Nivedita Vikas Nadkarni, Hai V. Nguyen, Gek Hsiang Lim, David Bruce Matchar, Dennis Chuen Chai Seow, Nicolas K. K. King, Marcus Eng Hock Ong

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2018

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Abstract

Background

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.

Methods

Using 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.

Results

Of 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.

Conclusions

Adult survivors of major blunt trauma can be risk-stratified at discharge for long-term support.
Literature
1.
Gubler KD, Davis R, Koepsell T, Soderberg R, Maier RV, Rivara FP. Long-term survival of elderly trauma patients. Arch Surg. 1997;132:1010–4. [cited 2017 Jan 18].
2.
Mullins RJ, Mann NC, Hedges JR, Worrall W, Helfand M, Zechnich AD, et al. Adequacy of hospital discharge status as a measure of outcome among injured patients. JAMA. 1998;279:1727–31. [cited 2017 Jan 26].
3.
Callcut RA, Wakam G, Conroy AS, Kornblith LZ, Howard BM, Campion EM, et al. Discovering the truth about life after discharge. J Trauma Acute Care Surg. 2016;80:210–7. [cited 2017 Jan 18].
4.
Santry HP, Psoinos CM, Wilbert CJ, Flahive JM, Kroll-Desrosiers AR, Emhoff TA, et al. Quadrimodal distribution of death after trauma suggests that critical injury is a potentially terminal disease. J Crit Care. 2015;30:656.e1–7. [cited 2017 May 26].
5.
Mitchell RJ, Cameron CM, McClure R. Higher mortality risk among injured individuals in a population-based matched cohort study. BMC Public Health. 2017;17:150. [cited 2017 May 26].
6.
Davidson GH, Hamlat CA, Rivara FP, Koepsell TD, Jurkovich GJ, Arbabi S. Long-term survival of adult trauma patients. JAMA. 2011;305:1001. [cited 2017 Jan 18].
7.
Cameron CM, Purdie DM, Kliewer EV, McClure RJ. Ten-year health service use outcomes in a population-based cohort of 21,000 injured adults: the Manitoba injury outcome study. Bull World Health Organ. 2006;84:802–10. [cited 2017 Jan 18].
8.
MacKenzie E, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–78.
9.
Claridge JA, Leukhardt WH, Golob JF, McCoy AM, Malangoni MA. Moving beyond traditional measurement of mortality after injury: evaluation of risks for late death. J Am Coll Surg. 2010;210:788–94. [cited 2017 Jan 18].
10.
Wong TH, Nguyen HV, Chiu MT, Chow KY, Ong MEH, Lim GH, et al. The low fall as a surrogate marker of frailty predicts long-term mortality in older trauma patients. PLoS One. 2015;10:e0137127.
11.
Palmer CS, Gabbe BJ. Cameron PA. Defining major trauma using the 2008 abbreviated injury scale. Injury. 2016;47:109–15. [cited 2017 Feb 17].
12.
Ho AF, Chew D, Wong TH, Ng YY, Pek PP, Lim SH, et al. Prehospital Trauma Care in Singapore. Prehosp Emerg Care. 2014.
13.
14.
Wong TH, Krishnaswamy G, Nadkarni NV, Nguyen HV, Lim GH, Bautista DCT, et al. Combining the new injury severity score with an anatomical polytrauma injury variable predicts mortality better than the new injury severity score and the injury severity score: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2016;24:25. [cited 2016 May 2].
15.
Pape H, Friess T, Liener U, Ruchholtz S, Schmucker U, Sturm J, et al. Development of geriatric trauma centers - an effort by the German Society for Trauma and Orthopaedics. Injury. 2014;45:1513–5.
16.
Jacobs D, Plaisier BR, Barie PS, Hammond JS, Holevar MR, Sinclair KE, et al. Practice management guidelines for geriatric trauma: the EAST practice management guidelines work group. J Trauma. 2003;54:391–416.
17.
Goodmanson NW, Rosengart MR, Barnato AE, Sperry JL, Peitzman AB, Marshall GT. Defining geriatric trauma: when does age make a difference? Surgery. 2012;152:668–74. [cited 2016 Jun 9] 5.
18.
Caterino JM, Valasek T, Werman HA. Identification of an age cutoff for increased mortality in patients with elderly trauma. Am J Emerg Med. 2010;28:151–8. [cited 2016 Jun 9].
19.
20.
Zhang Z, Kattan MW. Drawing nomograms with R: applications to categorical outcome and survival data. Ann Transl Med. 2017;5:211. [cited 2018 Mar 7].
21.
Hakkarainen TW, Arbabi S, Willis MM, Davidson GH, Flum DR. Outcomes of patients discharged to skilled nursing facilities after acute care hospitalizations. Ann Surg. 2016;26(3):280–5. [cited 2017 May 26].
22.
Brenneman FD, Boulanger BR, McLellan BA, Culhane JP, Redelmeier DA. Acute and long-term outcomes of extremely injured blunt trauma victims. J Trauma. 1995;39:320–4. [cited 2017 Jan 18].
23.
Carrillo EH, Richardson JD, Malias MA, Cryer HM, Miller FB. Long term outcome of blunt trauma care in the elderly. Surg Gynecol Obstet. 1993;176:559–64. [cited 2017 Jan 18].
24.
Redmill DA, McIlwee A, McNicholl B, Templeton C. Long term outcomes 12 years after major trauma. Injury. 2006;37:243–6. [cited 2017 Jan 18].
25.
Kaplan SJ, Pham TN, Arbabi S, Gross JA, Damodarasamy M, Bentov I, et al. Association of Radiologic Indicators of frailty with 1-year mortality in older trauma patients. JAMA Surg. American Medical Association; 2017 ;152:e164604. [cited 2017 Feb 17].
26.
Leeper CM, Lin E, Hoffman M, Fombona A, Zhou T, Kutcher M, et al. Computed tomography abbreviated assessment of sarcopenia following trauma. J Trauma Acute Care Surg. 2016;80:4–11. [cited 2017 May 26].
27.
Haider AH, Young JH, Kisat M, Villegas CV, Scott VK, Ladha KS, et al. Association between intentional injury and long-term survival after trauma. Ann Surg. 2014;259:985–92. [cited 2017 Jan 26].
28.
Hwabejire J, Kaafarani H, Lee J, Yeh D, Fagenholz P, King D, et al. Patterns of injury, outcomes, and predictors of in-hospital and 1-year mortality in nonagenarian and centenarian trauma patients. JAMA Surg. 2014;149:1054–9.
29.
Moore L, Stelfox HT, Turgeon AF, Nathens A, Bourgeois G, Lapointe J, et al. Hospital length of stay after admission for traumatic injury in Canada: a multicenter cohort study. Ann Surg. 2014;260:179–87.
30.
Moore L, Cisse B, Batomen Kuimi BL, Stelfox HT, Turgeon AF, Lauzier F, et al. Impact of socio-economic status on hospital length of stay following injury: a multicenter cohort study. BMC Health Serv Res. 2015;15:285. [cited 2017 Jan 21].
31.
Ayoung-Chee P, McIntyre L, Ebel BE, Mack CD, McCormick W, Maier RV. Long-term outcomes of ground-level falls in the elderly. J Trauma Acute Care Surg. 2014;76:498–503. [cited 2016 Jun 9] discussion 503.
32.
Haider A, Chang DC, Haut ER, Cornwell EE, Efron DT. Mechanism of injury predicts patient mortality and impairment after blunt trauma. J Surg Res. 2009;153:138–42.
33.
Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Tang A, O’Keeffe T, et al. Validating trauma-specific frailty index for geriatric trauma patients: a prospective analysis. J Am Coll Surg. 2014;219:10–7.
34.
McGwin G, Melton SM, May AK, Rue LW. Long-term survival in the elderly after trauma. J Trauma. 2000;49:470–6. [cited 2017 Jan 18].
35.
Ackland HM, Pilcher D V., Roodenburg OS, McLellan SA, Cameron PA, Cooper DJ, et al. Danger at every rung: epidemiology and outcomes of ICU-admitted ladder-related trauma. Injury. Elsevier; 2016 ;47:1109–1117. [cited 2016 Aug 14].
36.
Lapostolle F, Gere C, Borron SW, Pétrovic T, Dallemagne F, Beruben A, et al. Prognostic factors in victims of falls from height. Crit Care Med. 2005;33:1239–42. [cited 2017 Jan 18].
37.
Tebby J, Lecky F, Edwards A, Jenks T, Bouamra O, Dimitriou R, et al. Outcomes of polytrauma patients with diabetes mellitus. BMC Med. 2014;12:111.
38.
Ahmad R, Cherry RA, Lendel I, Mauger DT, Service SL, Texter LJ, et al. Increased hospital morbidity among trauma patients with diabetes mellitus compared with age- and injury severity score-matched control subjects. Arch. Surg. 2007;142:613–8. [cited 2016 Apr 29].
39.
Brown AW, Leibson CL, Mandrekar J, Ransom JE, Malec JF. Long-Term Survival After Traumatic Brain Injury. J. Head Trauma Rehabil. 2014;29:E1–8. [cited 2017 Jan 18].
40.
Fazel S, Wolf A, Pillas D, Lichtenstein P, Långström N. Suicide, Fatal Injuries, and other causes of premature mortality in patients with traumatic brain injury. JAMA Psychiat. 2014;71:326. [cited 2017 May 27].
41.
Joseph B, Pandit V, Rhee P, Aziz H, Sadoun M, Wynne J, et al. Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer? J Trauma Acute Care. 2014;76:196–200.
42.
Chen A, Chan V, Zagorski B, Parsons D. Colantonio a. Factors associated with living setting at discharge from inpatient rehabilitation after acquired brain injury in Ontario, Canada. J Rehabil Med. 2014;46:144–52. [cited 2016 Jun 2].
43.
Mubang RN, Stoltzfus JC, Cohen MS, Hoey BA, Stehly CD, Evans DC, et al. Comorbidity-polypharmacy score as predictor of outcomes in older trauma patients: a retrospective validation study. World J Surg. 2015;39:2068–75. [cited 2016 Jun 2].
44.
Venkataraman K, Fong NP, Chan KM, Tan BY, Menon E, Ee CH, et al. Rehabilitation outcomes after inpatient rehabilitation for lower extremity amputations in patients with diabetes. Arch Phys Med Rehabil. 2016;97:1473–80. [cited 2017 Jun 5].
45.
Miller R, Patton M, Graham RM, Hollins D. Outcomes of trauma patients who survive prolonged lengths of stay in the intensive care unit. J Trauma. 2000;48:229–34.
46.
Chen C, Koh GC, Naidoo N, Cheong A, Fong NP, Tan YV, et al. Trends in length of stay, functional outcomes, and discharge destination stratified by disease type for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005. Arch. Phys. Med. Rehabil. 2013;94:1342–51.
47.
Gabbe BJ, Simpson PM, Harrison JE, Lyons RA, Ameratunga S, Ponsford J, et al. Return to work and functional outcomes after major trauma: who recovers, when, and how well? Ann Surg. 2016;263:623–32. [cited 2016 Jun 29].
48.
Rainer TH, Yeung JHH, Cheung SKC, Yuen YKY, Poon WS, Ho HF, et al. Assessment of quality of life and functional outcome in patients sustaining moderate and major trauma: a multicentre, prospective cohort study. Injury. 2014;45:902–9. [cited 2016 May 11].
49.
Overgaard M, Høyer CB, Christensen EF. Long-Term Survival and health-related quality of life 6 to 9 years after trauma. J Trauma Inj Infect Crit Care. 2011;71:435–41. [cited 2017 Jan 18].
50.
Garshick E, Kelley A, Cohen SA, Garrison A, Tun CG, Gagnon D, et al. A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord. 2005;43:408–16. [cited 2017 May 27].
51.
Frankel HL, Coll JR, Charlifue SW, Whiteneck GG, Gardner BP, Jamous MA, et al. Long-term survival in spinal cord injury: a fifty year investigation. Spinal Cord. 1998;36:266–74. [cited 2017 May 27].
Metadata
Title
One-year and three-year mortality prediction in adult major blunt trauma survivors: a National Retrospective Cohort Analysis
Authors
Ting Hway Wong
Nivedita Vikas Nadkarni
Hai V. Nguyen
Gek Hsiang Lim
David Bruce Matchar
Dennis Chuen Chai Seow
Nicolas K. K. King
Marcus Eng Hock Ong
Publication date
01-12-2018
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-018-0497-y

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