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Abstract
Aims, Objectives and Background To date, few studies effectively quantify the long-term incidence of death directly related to injury.
The absence of detailed mortality data and underlying cause of death information following trauma results in an inadequate understanding and a potential underestimation of the true consequences of injury on an individual and population level.
This study takes a nationwide approach to identify the true one-year mortality in patients due to serious injury in Scotland, evaluating survivorship in relation to other pre-existing co-morbidities and incidental causes of death.
Method and Design This retrospective cohort study assessed the one-year mortality of adult trauma patients with an Injury Severity Score > 9 during 2020 using the Scottish Trauma Audit Group (STAG) registry linked to inpatient hospital data and death certificate records. Patients were divided into three distinct subgroups: death due to injury, death due to another cause, but injury was a contributory factor, and death due to a separate cause. These were subsequently analysed to determine risk factors linked to death. Kaplan-Meier curves and Cox regression were used for survival analysis to evaluate mortality.
Kaplan-Meier survival curve of the 2020 STAG cohort of traumatically injured adult patients who died within 365 days post-trauma hospitalisation stratified by underlying cause of death subgroup: trauma, trauma-contributed and non-trauma
Results and Conclusion 4056 patients were analysed with a median age 63 years and male predominance (55.2%). 782 patients died within 365 days (19.3%), with 55% occurring post-discharge. 47.7% of all deaths were attributable to trauma, and 35.3% were a direct consequence of injury. Non-traumatic deaths accounted for 20.3% and 79.4% in-hospital and post-discharge deaths respectively, most frequently due to circulatory, neoplastic and respiratory disease (37.7%, 12.3%, 9.1%, respectively). GCS < 8, modified Charlson Comorbidity score > 5, Injury Severity Score >25, Head AIS >3, Sex, and Age were independent risk factors for mortality at one year. Approximately 20% of patients died within 365 days due to trauma. Although early deaths reflect the bulk of trauma-related mortality, our sample demonstrated a significantly higher post-discharge one-year mortality than previously appreciated.