European Journal of Epidemiology

, Volume 27, Issue 3, pp 233–241 | Cite as

Time dependent influence of host factors on outcome after trauma

  • Olof Brattström
  • Emma Larsson
  • Fredrik Granath
  • Louis Riddez
  • Max Bell
  • Anders Oldner
INJURY EPIDEMIOLOGY

Abstract

The impact of host factors, such as gender and co-morbidity, on mortality after trauma has been debated. Quantification of risk factors is dependent on methodological considerations including follow-up time, definitions and adjustment of potential confounders. Optimal follow-up time of trauma patients remains to be elucidated. We investigated the impact of gender and co-morbidity on short and long term mortality in a cohort including 4,051 patients from a level 1 trauma centre. Data from the trauma cohort were linked to validated national registries. 30 and 360-day survival were analysed with logistic and Cox regression, respectively. Long term survival was also estimated as standardardized mortality ratio, which implies a comparison with a matched general population. The influence of host factors on outcome after trauma differed over time. Male gender was an independent risk factor for mortality at 1 year but not at 30-days post-injury, even after adjustment for clinically relevant confounders. This gender difference was also apparent when comparing mortality rates with the general population. Moreover, the effect of gender seems to be restricted to elderly patients. The presence of co-morbidity became a significant risk factor beyond 30 days after trauma, suggesting that this patient group may benefit from a more thorough follow up after hospital discharge. A persistent excess mortality compared to the general population was still seen 1 year after the trauma. Our findings indicate that the effect of trauma is not limited to the early post-injury period but adversely affects the long term outcome.

Keywords

Trauma Outcome Mortality Standardized mortality ratio Co-morbidity Gender 

Abbreviations

AIS

Abbreviated Injury Scale

CI

Confidence intervals

GCS

Glasgow Coma Scale

HR

Hazards ratio

ICD-10

International classification of diseases

IQR

Interquartile ranges

ISS

Injury severity score

NBHW

Swedish National Board of Health and Welfare

OR

Odds ratio

SAP

Systolic arterial blood pressure

SMR

Standardized mortality ratio

TARN

Trauma audit and research network

Notes

Acknowledgments

We are sincerely grateful to our trauma registry nurses Lisbeth Bergendal, Lena Jansson and Katarina Ramsberg-Enegren for their invaluable work with the trauma registry. We also thank Dr Timothy Baker for providing linguistic expertise. This study was supported by the Laerdal Foundation, the Magn Bergvall Foundation, the LPS Medical Foundation, the Cancer and Traffic Injury Fund, Funds from Karolinska Institutet and the Swedish Society of Medicine. Financial support was also provided through the regional agreement on medical and clinical research (ALF) between Stockholm County Council and Karolinska Institutet.

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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Olof Brattström
    • 1
    • 2
  • Emma Larsson
    • 2
    • 3
  • Fredrik Granath
    • 4
  • Louis Riddez
    • 3
  • Max Bell
    • 1
    • 2
  • Anders Oldner
    • 1
    • 2
  1. 1.Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
  2. 2.Department of Anesthesiology, Surgical Services and Intensive Care MedicineKarolinska University Hospital, SolnaStockholmSweden
  3. 3.Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
  4. 4.Department of Medicine, Clinical Epidemiology UnitKarolinska InstitutetStockholmSweden

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