Trauma Patients Fare Poorly After Hospital Discharge

March 8, 2011 -- Trauma patients who survive their initial injuries are at high risk for dying in the years that follow, and the risk is especially high for patients who enter nursing homes, a new study shows.

The analysis of more than 120,000 adults treated for trauma in Washington state suggests that hospitals are doing a better job of keep patients alive. But close to one in six patients who survived their injuries died within three years of hospital discharge -- almost three times the expected death rate for the population.

And about twice as many non-elderly patients discharged to nursing homes died than did patients who went home following hospitalization.

This mortality difference persisted even after researchers adjusted the data to reflect the fact that the nursing home patients tended to be more functionally impaired than patients who were able to go home.

Focus on Nursing Homes

The study, published in TheJournal of the American Medical Association, is among the first to examine long-term mortality among trauma patients.

“People should not conclude from these findings that nursing homes are doing something wrong or that they are harming patients,” study co-researcher Saman Arbabi, MD, MPH, of the University of Washington, Seattle tells WebMD. “The patients who went to these facilities were different, and even though we tried to control for this, we may not have been totally successful.”

But Arbabi adds that efforts to improve long-term survival among trauma patients should probably focus on nursing homes.

The study included 124,421 adults living in Washington who were hospitalized for trauma between January 1995 and December 2008. The average age of the patients was 53; 59% were male.

More than half of patients went home without paid nursing and nearly a quarter were discharged to nursing homes. The rest went home with nursing help or went to rehabilitation facilities.

After Hospital Discharge

Among the study’s major findings:

• Almost three times as many patients died following hospital discharge (21,045) as died during their hospital stay (7,243).
• Hospitalization deaths dropped steadily during the 14-year study, from 8% in 1995 to 4.9% in 2008.
• During the same period, deaths in the years following hospital discharge increased from 4.7% to 7.4%.
• Roughly one in three patients (34%) discharged to nursing homes died within three years.

Arbabi credits a coordinated, statewide trauma program for the improved survival among hospitalized patients.

“Clearly we are doing a better job getting patients to hospitals and keeping them alive once they get there,” he says. “But the post-discharge outcomes are not as good.”

The overall death rate within a year of injury was about 10%, rising to 16% within three years.

Death rates among patients discharged to rehabilitation facilities were not significantly different from those of patients who went home.

Nursing home quality-improvement educator Carol Siem, RN, MSN, tells WebMD she is not surprised by the findings. She says many younger trauma patients who are sent to nursing homes have catastrophic head injuries.

Siem is a team leader with Missouri’s nursing home Quality Improvement Program.

“These patients are usually there because there injuries are so serious that their family members can’t care for them at home,” she says.