PREDICTING EARLY VERSUS LATE IN-HOSPITAL MORTALITY IN THE TRAUMA POPULATION

Objectives: The analysis of trauma mortality is critical for the development of improved trauma care systems. This study aimed to evaluate non-survivors who were admitted to a level I trauma center but then later died, in terms of prediction of who would expire early versus late.

Methods: This is a single-center study of Trauma Registry data, from July 3, 2016, to February 24, 2022. The inclusion criteria were based on age (≥18 years) and in-hospital mortality. A linear regression was performed to ascertain the effects of predictor variables on the likelihood that an expired adult trauma patient would experience an early vs late in-hospital death.

Results: 546 patients (mean age 58) were included in the analysis based on the methods section's requirements. A significant regression equation was found (F(31,45)=7.74, p<.01), with an R2 of 0.73. Trauma patients who may experience an earlier death were those with increasing injury severity scores (β=-.004, p=.01), activation of massive transfusion protocol (β=-.18, p<.01), co-morbid advanced directive limiting care (β=-.22, p<.01), COPD (β=-.13, p=.05), personality disorder (β=-.20, p=.03), and ED death location (β=-.28, p<.01). Patients were more likely to experience later in-hospital mortality included those with increasing ICU stays (β=.04, p<.01), and co-morbid dementia (β=.18, p=.02).

Conclusion: There were several significant differences in non-survivors of trauma who experienced early versus late in-hospital mortality. Those that died early had a higher injury severity score, were activated with a massive transfusion protocol, and likely expired in the ED. Those who expired later had increasing days in the ICU. Co-morbidity was a factor in both early versus late mortality in trauma.