Within three years after hospital discharge, a "significant excess mortality rate" of 16% of trauma patients had died, and for those discharged to a skilled nursing facility, the mortality rate was 34%, no matter their age.
Nearly 10% of the patients died within the first year after discharge.
By comparison, the expected mortality of the general population, adjusted for age and sex, was 6% after three years.
Those are findings from a report looking back at 124,421 patients treated at 78 trauma hospitals in Washington State between 1995 and 2008, perhaps the largest study of its kind to look at trauma mortality after hospital 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," wrote principal author Giana H. Davidson, MD, of Harborview Injury Prevention and Research Center in Seattle and colleagues.
"Despite increases in federal regulations intended to improve skilled nursing facility care, there has been insufficient impact on quality or public reputation," she wrote. "Further investigation is needed to determine if more health clinician oversight, funding, or rehabilitation therapy is needed to improve the care of patients at skilled nursing facilities following discharge for injury."
The authors also suggest that to improve care for trauma patients after hospital discharge, a much longer period than the standard 30-day mortality measure should be used. "We may be seeing a downwind shift in mortality from improvements in the acute care period," they wrote.
The study is published in the March 8 edition of the Journal of the American Medical Association.
In-hospital deaths for these trauma patients actually declined during the 13-year study period. But after discharge, mortality rates rose, suggesting that there may be improvements in trauma care but not in care after acute hospitalization.
"These results suggest that in an adult trauma patient, acute injury is not just a brief psychological setback to a healthy life, but rather signals significant long-term mortality in a large number of patients," they wrote.
In their study, 7,243 of the 124,421 trauma patients died during their trauma hospitalization, but 21,045 died within three years after discharge. Compared with a 34% mortality rate for those discharged to a skilled nursing facility, those discharged home without assistance had a 4% mortality rate by year three, those who went home with assistance, 15.9%; and those discharged to a rehabilitation facility had a 12% rate of death.
Also strongly predictive of death in the first year after discharge was age, systolic blood pressure less than 90 mm Hg, those with a Glasgow Coma Scale score of less than 9, male sex, and a mechanism of fall or blunt injury.
The authors noted that Washington State has five levels of hospital trauma designation, and all were included in the study.