I wanted to pass on this article on Trauma Mortality to anyone who is interested in reading. This was posted on Medscape and I think it is appropriate for this month topic of Brain Injury Awareness. There are a lot of topics out on Medscape all with interesting reads. Health care professionals can get CEU's. Take a look. You can follow on Facebook or twitter.

Kind of off topic this week is me. I have been sick for about 6 weeks with a flu like virus. I have missed about 8 days of work now and have been stuck on my couch. Can't even seem to get up long enough to do anything. I have been tested for almost everything, but nothing has shown up. Kind of strange since I can't seem to be able to walk to my mail box without even becoming short of breath and diaphoretic. At least I am not coughing now. That was a big issue. Slept in a chair for about 2 weeks.

Any way, As most of you know I work at Courage Center. I miss my patients and all of our great staff. I recently was at the Emergency Room, and the nurse asked me how can you work there. I told her, because everyday I see miracles. I really do. When I worked in trauma, as a nurse coordinator, I saw death weekly. Could not stand to watch people have to make the decisions on their loved ones wishes to live or die. I became distant and untouched by what I saw. That was my signal that I needed to do something else.

She told me about how she had seen our patients out on the ski kill and could not believe their courage. She said the ski lift would be daunting for someone with a disability. She could not believe that these people did it, and all with a disability. I said, see...miracles!

One of the biggest challenges of working with patients in rehab is watching them at their starting point. See what they are like when they come in. After most people have been in a coma, they say their first memories start when they are in rehab. I have heard this over and over again.

I have seen where they come from, I have been on the other side in the ICU. Patients who become lines and ventilators and medication and pressure monitoring, fevers and unconsciousness. In essence their trauma diagnosis. The battle for life and death. The battle to save some resemblance of the person who was here. I have seen the despair of families, and the decision to stop and not do any more. I have also seen the despair of continuing on and living with that decision. That is where new life and chances begin.

Suziecho12

Authors and Disclosures

Journalist

Jim Kling

Jim Kling is a freelance writer for Medscape.

Disclosure: Jim Kling has disclosed no relevant financial relationships.

From Medscape Medical News

Mortality Rate High in Trauma Patients

Jim Kling

March 11, 2011 — After admission for trauma, adults experience a 16% cumulative mortality rate during the next 3 years compared with an expected 6% for the general population, according to a study published in the March 9 issue of JAMA. Higher mortality rates were associated with discharge to a skilled nursing facility, regardless of patient age.

Most studies of trauma outcomes have focused on in-hospital mortality and complications, and there are few data available on long-term outcomes. Giana H. Davidson, MD, MPH, from Harborview Injury Prevention and Research Center and the Department of Surgery, University of Washington, Seattle, and colleagues conducted a retrospective cohort study of 124,421 injured adult patients from January 1995 to December 2008. Patient data were obtained from the Washington State Trauma Registry, linked to death certificate data. The researchers used Kaplan-Meier and Cox proportional hazards models for data analysis.

Of the patients, 7243 died before hospital discharge, and 21,045 died after hospital discharge. Three years after injury, the cumulative mortality rate was 16% (95% confidence interval [CI], 15.8% - 16.2%) compared with a cumulative mortality of 5.9% (95% CI, 5.9% - 5.9%) for the general population.

During the study period, the researchers found that in-hospital mortality improved from 8% (n = 362; 95% CI, 7.2% - 8.8%) to 4.9% (n = 600; 95% CI, 4.5% - 5.2%).

After adjustment for confounders, the researchers found that discharge to skilled nursing facilities was associated with higher cumulative risk for death (adjusted hazard ratio, 1.41 [95% CI, 0.72 - 2.76] for patients aged 18 to 30 years, 1.92 [95% CI, 1.36 - 2.73] for patients aged 31 to 45 years, 2.02 [95% CI, 1.39 - 2.93] for patients aged 46 to 55 years, 1.93 [95% CI, 1.40 - 2.64] for patients aged 56 to 65 years, 1.49 [95% CI, 1.14 - 1.94] for patients aged 66 to 75 years, 1.54 [95% CI, 1.27 - 1.87] for patients aged 76 to 80 years, and 1.38 [95% CI, 1.09 - 1.74] for patients older than 80 years).

Other predictors of mortality included

maximum head injury score on Abbreviated Injury Score scale (hazard ratio [HR], 1.20; 95% CI, 1.13 - 1.26),
Injury Severity Score (HR, 0.98; 95% CI, 0.97 - 0.98),
Functional Independence Measure (HR, 0.89; 95% CI, 0.88 - 0.91),
injury resulting from a fall (HR, 1.43; 95% CI, 1.30 - 1.58),
having Medicare (HR, 1.28; 95% CI, 1.15 - 1.43), or
having other government insurance (HR, 1.65; 95% CI, 1.47 - 1.85).

"Despite increases in federal regulations intended to improve skilled nursing facility care, there has been insufficient impact on quality or public reputation. Further investigation is needed to determine if more health clinician oversight, funding, or rehabilitation therapy is needed to improve the care of the patients at skilled nursing facilities following discharge for injury," the authors write.

The authors have disclosed no relevant financial relationships.

JAMA. 2011;305:1001-1007. Abstract

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Friday, March 11, 2011