In big news this week, it has been reported that after undergoing trauma and being hospitalized, a patient has a higher risk of dying when discharged to a “skilled” nursing facility compared to just heading back to the comforts of home. In addition it has been found that 16% of patients died within three years of their initial injury, compared to an expected population mortality rate of about six percent.
Trauma refers to a body wound or shock produced by sudden physical injury, as from violence or accident. It can also be described as a physical wound or injury, such as a fracture or blow. Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death.
In some background material to the Journal of the American Medical Association report, it states:
“To date, there have been few large studies evaluating long term mortality in trauma patients and identifying predictors that increase risk for death following hospital discharge. Information on the short and long term causes of death following discharge for injury could potentially identify gaps in care amenable to improvement, and allow for counseling of patients and their families about prognosis following traumatic injuries.”
Giana H. Davidson, M.D., M.P.H., of the Harborview Injury Prevention and Research Center, Seattle, and colleagues conducted a study to examine the long-term mortality of Washington State trauma patients.
Analysis indicated that cumulative mortality following injury was 9.8% at one year and 16% at three years. Age and discharge to a skilled nursing facility strongly predicted risk of death during the follow up period and time to death following injury.
Of the patients in the study, 7,243 died (5.8%) during their trauma hospitalization; 21,045 died following hospital discharge. The proportion of patients who died while in the hospital declined each year of the study, from 8% in 1995 to approximately 4.9% in 2008, whereas long-term cumulative mortality increased from 4.7% to 7.4%.
The study’s authors continue:
“Overall, cumulative mortality was significantly lower for those patients discharged home with or without assistance and patients discharged to rehabilitation facilities than for patients discharged to a skilled nursing facility, who had a 34% cumulative mortality by three years post discharge. Our results indicate that skilled nursing facility discharge status may at least be a marker for significantly higher risk of subsequent mortality and may be the focus for future research and intervention, especially in the age group of 31 to 80 year olds. There are significant differences in physical therapy and occupational therapy for patients in rehabilitation programs compared with patients at skilled nursing facilities, even when comparing similar demographic characteristics and medical complexity.”
In the United States, a “Skilled Nursing Facility” is a nursing home certified to participate in, and be reimbursed by Medicare. Medicare is the federal program primarily for the aged who contributed to Social Security and Medicare while they were employed. A “Nursing Facility” is a nursing home certified to participate in, and be reimbursed by Medicaid.
The researchers add that future research in surgical patients should focus on outcomes longer than the standard reporting of 30-day mortality because a downwind shift in mortality may be occurring from improvements in the acute care period.
“Interventions should be aimed at improving the care of the injured patient following discharge from the hospital and narrow the gap in outcomes for those patients discharged to skilled nursing facilities.”
Written by Sy Kraft, B.A.