The Short and the Long of it: Timing of Mortality for Older Adults in a State Trauma System

Although the impact of injury extends beyond the hospital stay, trauma center performance metrics typically focus on in-hospital mortality and ignore long-term mortality. Because of this, a new study conducted by PISC Senior Scholar Elinore Kaufman, MD, MSHP, past trainee Alexis M. Zebrowski, PhD, MPH, Executive Committee member Daniel N. Holena, MD, Phillipe Loher, PISC Center Director Douglas Wiebe, PhD, and External Advisory Board member Brendan Carr, MD, MS aimed to investigate the characteristics of both in-hospital and long-term mortality rates among older adults in a state trauma system. After matching trauma registry records in Pennsylvania to Medicare claims and examining regression outcomes, the study found that of the 15,451 patients treated at 28 centers, 8.1% died before discharge or were discharged to hospice. It also found that 3.4% died within 30 days, and of those patients 92.5% were injured due to fall and 75% sustained head injuries. Survival at 1 year was higher in patients discharged home compared to those discharged to a skilled nursing facility or long-term acute care hospital. The authors conclude that, "Hospital rankings for in-hospital mortality correlate poorly with long-term outcomes. These findings underscore the importance of looking beyond survival to discharge for quality improvement and benchmarking."

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