The Impact of Non-trauma Factors on Trauma Patient Mortality and Hospital Resource Utilization: Population-Based Retrospective Review.

Abstract

Background: The death of trauma patients with low injury severity scores (ISS) may not be fully explained by the severity of their injuries. Our objective was to evaluate preexisting conditions (PECs) that may contribute to the mortality rate of and hospital resources consumed by patients with low ISS.

Methods: Trauma patients with ISS <9 were selected from the National Trauma Database Bank [NTDB] [2019-21]. Bivariate and multivariate analysis identified the risk factors associated with mortality, adjusting for secondary PECs, mechanism of injury, AIS body region, vital signs, and blood transfusion. A t test was used to compare PEC status with intensive care unit (ICU) and hospital length of stay (LOS) for significant differences (P < .05).

Results: 1,689,392 patients suffered mild injuries [59.1% male, mean age 45.2, 8579 expired (0.5%)]. Mortality was associated with the presence of several risk factors, especially advanced directive [OR = 9.13, P < .001], cirrhosis [OR = 8.55, P < .001], disseminated cancer [OR = 8.53, P < .001], congestive heart failure (CHF) [OR = 6.62, P < .001], chronic renal failure (CRF) [OR = 6.16, P < .001], chemotherapy for cancer [OR = 5.64, P < .001], peripheral arterial disease (PAD) [OR = 5.32, P < .001], myocardial infarction (MI) [OR = 4.96, P < .001], dementia [OR = 4.62, P < .001], and functionally dependent health [OR = 4.57, P < .001]. In addition, there was a relationship between the presence of several PECs and increased ICU and hospital LOS, especially cirrhosis, CRF, CHF, and PAD.

Discussion: Nontraumatic factors and preexisting conditions are associated with increased mortality and hospital resource consumption in trauma patients with a low ISS. They should be considered during clinical decision-making for these patients, who may otherwise masquerade as part of a low-risk population.