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Time to Death of Hospitalized Injured Patients as a Measure of Quality of Care

Olson, Christine J. MD; Brand, Dawn MS; Mullins, Richard J. MD; Harrahill, Maureen RN; Trunkey, Donald D. MD

The Journal of Trauma: Injury, Infection, and Critical Care: July 2003 - Volume 55 - Issue 1 - p 45–52
doi: 10.1097/01.TA.0000071291.17287.57

Background: In population-based studies, the quality of care delivered to injured patients is commonly judged by hospital survival rates. Evidence suggests injured patients surviving hospitalization remain at risk for death from their injuries after discharge. Patient characteristics associated with higher risk of late death are not completely defined.

Methods: The National Death Index is a government-maintained database composed of death certificate records from all decedents in the United States. Patients in a trauma registry were crosslinked to decedents in National Death Index on the basis of Social Security number or other unique identifiers. Decedents' time from injury to death was calculated. Logistic regression models were fit to those who died at hospital discharge and those who died in the first year after injury.

Results: Among 4,293 hospitalized injured patients recorded in a trauma registry, 157 died during hospitalization. Among the 4,136 discharged alive, 91 patients were linked to death certificate records filed in the 365 days after discharge. Patients over the age of 65 had a 15-fold greater odds of death than younger patients.

Conclusion: Trauma registry data cross-linked to vital statistics records is practicable. Patients who die in the year after injury differ from the traditional population used to evaluate quality of trauma care, and new standards are needed that evaluate long-term survival.

From the Department of Surgery (C.J.O., D.B., R.J.M., D.D.T.) and Trauma Program (M.H.), Oregon Health & Science University, Portland, Oregon.

Submitted for publication December 5, 2002.

Accepted for publication March 19, 2003.

Supported by grant R49/CCR-006283 from the U.S. Public Health Service, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia.

The authors are solely responsible for the contents of the article, and the opinions do not necessarily represent the views of the Centers for Disease Control and Prevention.

Poster Presentation at the 61st Annual Meeting of the American Association for the Surgery of Trauma, September 26-28, 2002, Orlando, Florida.

Address for reprints: Richard J. Mullins, MD, Department of Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Mail Code L223A, Portland, OR 97201-3098; email:

© 2003 Lippincott Williams & Wilkins, Inc.