Exploring the impact of traumatic injury on mortality: an analysis of the certified cause of death within one year of serious injury in the Scottish population

Craig, H. A., Lowe, D. J. , Khan, A., Paton, M. and Gordon, M. W.G. (2024) Exploring the impact of traumatic injury on mortality: an analysis of the certified cause of death within one year of serious injury in the Scottish population. Injury, 55(6), 111470. (doi: 10.1016/j.injury.2024.111470) (PMID:38461710)

Abstract

Background: Few studies effectively quantify the long-term incidence of death following injury. The absence of detailed mortality and underlying cause of death data results in limited understanding and a potential underestimation of the consequences at a population level. This study takes a nationwide approach to identify the one-year mortality following injury in Scotland, evaluating survivorship in relation to pre-existing comorbidities and incidental causes of death. Study 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 groups: trauma death, trauma-contributed death, and non-trauma death. Kaplan-Meier curves were used for survival analysis to evaluate mortality, and cox proportional hazards regression analysed risk factors linked to death. Results: 4056 patients were analysed with a median age 63 years (58–88) and male predominance (55.2 %). Falls accounted for 73.1 % of injuries followed by motor vehicle accidents (16.3 %) and blunt force (4.9 %). Extremity was the most commonly injured region overall followed by chest and head. However, head injury prevailed in those who died. The registry demonstrated a one-year mortality of 19.3 % with 55 % deaths occurring post-discharge. Of all deaths reported, 35.3 % were trauma deaths, and 47.7 % were trauma-contributed deaths. These groups accounted for over 70 % of mortality within 30 days of hospital admission and continued to represent the majority of deaths up to 6 months post-injury. Patients who died after 6 months were mainly the result of non-traumatic causes, frequently circulatory, neoplastic, and respiratory diseases (37.7 %, 12.3 %, 9.1 %, respectively). Independent risk factors for one-year mortality included a GCS ≤ 8, modified Charlson Comorbidity score >5, Injury Severity Score >25, serious head injury, age and sex. Conclusion: With a one-year mortality of 19.3 %, and post-discharge deaths higher than previously appreciated, patients can face an extended period of survival uncertainty. As mortality due to index trauma lasted up to 6 months post-admission, short-term outcomes fail to represent trauma burden and so cogent survival predictions should be avoided in clinical and patient settings.

• Item Type: Articles
• Keywords: Trauma registry, severe injury, trauma, major trauma, mortality, 1-year mortality, outcome, cause of death, Injury Severity Score, injury, multiple injuries.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lowe, Dr David and Gordon, Dr Malcolm

Creator Roles

Lowe, D.: Writing – review and editing
Gordon, M.: Conceptualization, Project administration, Writing – review and editing

• Authors: Craig, H. A., Lowe, D. J., Khan, A., Paton, M., and Gordon, M. W.G.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Injury
• Publisher: Elsevier
• ISSN: 0020-1383
• ISSN (Online): 1879-0267
• Published Online: 28 February 2024
• Copyright Holders: Copyright © 2024 The Authors
• First Published: First published in Injury 55(6):111470
• Publisher Policy: Reproduced under a Creative Commons license