Discovering the truth about life after discharge: Long-term trauma-related mortality.
Discovering the truth about life after discharge: Long-term trauma-related mortality.
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DOI：
10.1097/ta.0000000000000930
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发表时间：
2016-02
期刊：
影响因子：
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通讯作者：
Cohen MJ
中科院分区：
文献类型：
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作者：
Callcut RA;Wakam G;Conroy AS;Kornblith LZ;Howard BM;Campion EM;Nelson MF;Mell MW;Cohen MJ
创伤后的结果通常仅限于在出院时或短暂的随访时确定。这项研究调查了创伤后长期存活的自然历史。所有在2005-2012年间进行的队列研究中前瞻性登记的最高激活水平的患者都被选中。为了进行长期随访，患者必须在国家死亡指数(NDI 2013)最新可用数据之前至少一年进行登记。死亡时间和死因是根据死亡证明确定的。生存状态由我们机构或NDI查询的最新护理日期确定。Kaplan-Meier曲线按损伤严重程度(ISS)分层创建。将存活率与基于年龄、性别和种族的估计精算存活率进行比较。908名活动程度最高的患者(ISS中位数为18分)被随访了平均1.7年(IQR 1.0-2.9；最长9.8年)。存活率为99.8%。总存活率73%(663/908)。随访至少2年的患者存活率仅为62%(317/509)。损伤的严重程度预测了长期存活率(p<；.0001)，ISS>；=25的患者预后最差(5年存活率为57%)。对于所有的ISS组，存活率比预测的精算存活率要差[p<；0.001]。排除早期死亡(=30天)，观察到的存活率仍然显著低于估计的精算存活率[p<；0.002]。18%(44/245例死亡)的死亡发生在30天后。在晚期死亡中，53%发生在创伤后31天至1年之间。创伤相关死亡是出院后死亡的主要原因，占晚期死亡的43%。出院后死亡占创伤相关总死亡率的很大比例。尽管“活下来”出院了，但长期存活率比预计的精算存活率要差，这表明受伤的死亡率并不是“成功”出院就结束的。
Outcome after traumatic injury has typically been limited to determination at time of discharge or brief follow-up. This study investigates the natural history of long-term survival after trauma. All highest level activation patients prospectively enrolled in an on-going cohort study from 2005–2012 were selected. To allow for long-term follow-up, patients had to be enrolled at least 1 year prior to the latest available data from the National Death Index (NDI 2013). Time and cause of mortality was determined based upon death certificates. Survival status was determined by the latest date of either care in our institution or NDI query. Kaplan-Meier curves were created stratified for injury severity (ISS). Survival was compared with estimated actuarial survival based on age, gender, and race. 908 highest level activation patients (median ISS 18) were followed for a median 1.7 years (IQR 1.0 – 2.9; maximum 9.8 years). Survival data was available on 99.8%. Overall survival was 73% (663/908). For those with at least 2 year follow-up, survival was only 62% (317/509). Severity of injury predicted long-term survival (p<.0001) with those having ISS>=25 with the poorest outcome (57% survival at 5 years). For all ISS groups, survival was worse than predicted actuarial survival [p<0.001]. Excluding early deaths (<=30 days), observed survival was still significantly lower than estimated actuarial survival [p<0.002]. 18% (44/245 deaths) of all deaths occurred after 30 days. Amongst late deaths, 53% occurred between 31 days to 1 year post trauma. Trauma related mortality was the leading cause of post-discharge death accounting for 43% of the late deaths. Post-discharge deaths represent a significant percentage of total trauma related mortality. Despite having ‘survived’ to leave the hospital, long term survival was worse than predicted actuarial survival suggesting that the mortality from injury does not end at ‘successful’ hospital discharge.