Discovering the truth about life after discharge: Long-term XXXX related mortality.

@entity1 @entity2992 @entity3040 @entity204 @entity130
INTRODUCTION: Outcome after @entity130 has typically been limited to determination at time of discharge or brief follow-up. This study investigates the natural history of long-term survival after @entity130 . METHODS: All highest level activation @entity1 prospectively enrolled in an on-going cohort study from 2005-2012 were selected. To allow for long-term follow-up, @entity1 had to be enrolled at least 1 year prior to the latest available data from the National Death Index ( @entity3040 2013). Time and cause of mortality was determined based upon death certificates. Survival status was determined by the latest date of either care in our institution or @entity3040 query. Kaplan-Meier curves were created stratified for injury severity ( @entity2992 ). Survival was compared with estimated actuarial survival based on age, gender, and race. RESULTS: 908 highest level activation @entity1 (median @entity2992 18) were followed for a median 1.7 years (IQR 1.0 - 2.9; maximum 9.8 years). Survival data was available on 99.8%. Overall survival was 73% (663/908). For those with at least 2 year follow-up, survival was only 62% (317/509). Severity of injury predicted long-term survival (p<.0001) with those having @entity2992 >=25 with the poorest outcome (57% survival at 5 years). For all @entity2992 groups, survival was worse than predicted actuarial survival [p<0.001]. Excluding early @entity204 (<=30 days), observed survival was still significantly lower than estimated actuarial survival [p<0.002]. 18% (44/245 @entity204 ) of all @entity204 occurred after 30 days. Amongst late @entity204 , 53% occurred between 31 days to 1 year post @entity130 . @entity130 related mortality was the leading cause of post-discharge death accounting for 43% of the late @entity204 . CONCLUSION: Post-discharge @entity204 represent a significant percentage of total @entity130 related mortality. Despite having 'survived' to leave the hospital, long term survival was worse than predicted actuarial survival suggesting that the mortality from injury does not end at 'successful' hospital discharge. LEVEL OF EVIDENCE: Level 3, prognostic.
