Even if trauma patients don’t die in hospital, they are still at significant risk of death following discharge. So say Davidson and colleagues from the University of Washington, Seattle. They conducted a retrospective cohort study of 124 421 injured adult patients during a 14-year period up to 2008 who were admitted to hospital trauma units in Washington State. Of these, 7243 died before discharge and 21 045 died after discharge. Although in-hospital mortality rates fell from 8% to 4.9% over the period of the study, long-term cumulative mortality rates increased from 4.7% to 7.4%. Hence, in-hospital mortality rates are not reliable indicators of overall mortality rates from trauma, they concluded. Patients who were older and those who were discharged to a skilled nursing facility had the highest risk of death. Other predictors of mortality were advanced age, serious head injury and loss of functional independence.
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