The impact of premorbid conditions on temporal pattern and location of adult blunt trauma hospital deaths.

BACKGROUND: This study was designed to show the importance of age, presence of premorbid conditions, and the type of injury on time and location of adult inhospital trauma mortality.

METHODS: All acute blunt trauma deaths at a Level I urban trauma center between April 1, 1993 and March 31, 2003 were individually reviewed to collect data on the following variables: age, gender, presence and number of premorbid conditions, mechanisms of trauma, location of death, acute transfer from another hospital, delay to death, initial Glasgow Coma Score (GCS), Abbreviated Injury Score (AIS), Injury Severity Score (ISS), and revised trauma score (RTS). Bivariate analysis using simple logistic regression was used to show the association between each variable and delay to death. Variables significantly associated with death underwent multivariate analysis to yield adjusted odds ratios (aORs) with 95% confidence interval (CI).

RESULTS: During the study period there were 463 blunt trauma deaths (6.8%). Their mean age was 67.5 years, mean ISS was 22.6, mean GCS was 11.0, and 55.3% were male. Most deaths occurred in either the intensive care unit (45.8%) or the ward (46.4%); there were few deaths in the emergency department (6.8%) or the operating room (0.4%). The following were significant bivariate predictors for death: presence of premorbid conditions, number of premorbid conditions, age >60, pulmonary diseases, cardiac diseases, diabetes mellitus, neurologic diseases, GCS, AIS > or =4, and ISS. Multivariate analysis demonstrated the following significant findings: patients with severe thoracic injuries were significantly more likely to die in the first 6 hours (aOR = 1.37; CI = 1.12-1.68; p = 0.002); and patients with severe head injuries were more likely to die after 48 hours (aOR = 1.275; CI = 1.158-1.405; p = 0.0001). Older patients and those with neurologic diseases were more likely to die later and in a hospital ward (aOR = 2.18; CI = 1.25-3.81; p = 0.006). Men and women differed as to age, ISS, mechanism of injury, and type of injury, but not as to delay to death.

CONCLUSIONS: Age, body area injured, and presence and type of premorbid conditions are significant predictors of location of and delay to death after blunt trauma. We think that incorporating information on premorbid conditions is essential for mortality analysis in an aging population.