Quadrimodal distribution of death after trauma suggests that critical injury is a potentially terminal disease.

Autor: Santry HP; Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: heena.santry@umassmemorial.org., Psoinos CM; Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA., Wilbert CJ; Department of Emergency Medicine, MedStar Harbor Hospital, Baltimore, MD, USA., Flahive JM; Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA., Kroll-Desrosiers AR; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA., Emhoff TA; Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA., Kiefe CI; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2015 Jun; Vol. 30 (3), pp. 656.e1-7. Date of Electronic Publication: 2015 Jan 08.
DOI: 10.1016/j.jcrc.2015.01.003
Abstrakt: Background: Patterns of death after trauma are changing due to advances in critical care. We examined mortality in critically injured patients who survived index hospitalization.
Methods: Retrospective analysis of adults admitted to a Level-1 trauma center (1/1/2000-12/31/2010) with critical injury was conducted comparing patient characteristics, injury, and resource utilization between those who died during follow-up and survivors.
Results: Of 1,695 critically injured patients, 1,135 (67.0%) were discharged alive. As of 5/1/2012, 977/1,135 (86.0%) remained alive; 75/158 (47.5%) patients who died during follow-up, died in the first year. Patients who died had longer hospital stays (24 vs. 17 days) and ICU LOS (17 vs. 8 days), were more likely to undergo tracheostomies (36% vs. 16%) and gastrostomies (39% vs. 16%) and to be discharged to rehabilitation (76% vs. 63%) or skilled nursing (13% vs. 5.8%) facilities than survivors. In multivariable models, male sex, older age, and longer ICU LOS predicted mortality. Patients with ICU LOS >16 days had 1.66 odds of 1-year mortality vs. those with shorter ICU stays.
Conclusions: ICU LOS during index hospitalization is associated with post-discharge mortality. Patients with prolonged ICU stays after surviving critical injury may benefit from detailed discussions about goals of care after discharge.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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