Causes of excessive late death after trauma compared with a matched control cohort

Eriksson, Mats; Brattström, Olof; Larsson, Emma; Oldner, Anders

doi:10.1002/bjs.10197

Cited by 11 publications

(9 citation statements)

References 32 publications

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“…Furthermore, chronic opioid use was associated with increased mortality 6–18 months after trauma. Recent data indicate that postinjury mortality is increased for several years after trauma, and a large proportion of this excess mortality is attributed to substance abuse. Whether or not the participants in these studies were addicted to opioids is not clear, but an obvious risk of liberal opioid prescription after trauma is an associated rise in opioid dependence.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and outcomes of chronic opioid use following trauma

Oelreich

Eriksson

Brattström

et al. 2020

British Journal of Surgery

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Background The growing problem of opioid misuse has become a serious crisis in many countries. The role of trauma as a gateway to opioid use is currently not determined. The study was undertaken to assess whether traumatic injury might be associated with chronic opioid use and accompanying increased long‐term mortality. Methods Injured patients and controls from Sweden were matched for age, sex and municipality. After linkage to Swedish health registers, opioid consumption was assessed before and after trauma. Among injured patients, logistic regression was used to investigate factors associated with chronic opioid use, assessed by at least one written and dispensed prescription in the second quarter after trauma. Cox regression was employed to study excess risk of mortality. In addition, causes of death for postinjury opioid users were explored. Results Some 13 309 injured patients and 70 621 controls were analysed. Exposure to trauma was independently associated with chronic opioid use (odds ratio 3·28, 95 per cent c.i. 3·02 to 3·55); this use was associated with age, low level of education, somatic co‐morbidity, psychiatric co‐morbidity, pretrauma opioid use and severe injury. The adjusted hazard ratio for death from any cause 6–18 months after trauma for chronic opioid users was 1·82 (95 per cent c.i. 1·34 to 2·48). Findings were similar in a subset of injured patients with no pretrauma opioid exposure. Conclusion Traumatic injury was associated with chronic opioid use. These patients have an excess risk of death in the 6–18 months after trauma.

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Section: Discussionmentioning

confidence: 99%

Risk factors and outcomes of chronic opioid use following trauma

Oelreich

Eriksson

Brattström

et al. 2020

British Journal of Surgery

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“…These results suggest that early mortality in the lower ICED group could be attributed to a higher ISS, whereas both early and late mortality in the higher ICED group were influenced by the ISS and comorbidities. Despite improvements in early mortality (e.g., exsanguination), the rate of late mortality, or events occurring beyond 1 week after trauma, remained unchanged [ 45 ]. In one study reporting a late mortality rate of 2.36%, 38.69% of these cases involved victims older than 71 years [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of comorbidities on the prognoses of trauma patients: Analysis of a hospital-based trauma registry database

et al. 2018

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Here we conducted a retrospective analysis of hospital-based trauma registry database for evaluating the impacts of comorbidities on the prognosis for traumatized patients using Index of Coexistent Comorbidity Disease (ICED) scores. We analyzed the data of patients with blunt trauma who visited emergency department between January 1, 2011, and December 31, 2015 in Chang-Gung Memorial Hospital, Keelung branch, a single level I trauma center in the Northern Taiwan. All consecutive patients with blunt trauma who admitted to the intensive care unit or ordinary ward after initial managements in the emergency department were included. We measured the hospital mortality of blunt traumatized patients using alive discharge as a competing risk. To investigate conditional independence of mortality and ICED scores given Injury Severity Score (ISS), we used log-linear models for modeling independence structures. Overall, we included 4997 patients (median age [IQR], 59 years old (44–75 years); 55.3% male). The mortality rate of blunt traumatized patients was higher in the higher ICED scores group compared to lower ICED scores group (4.7% vs 1.8%, p < 0.001). Meanwhile, the higher ICED scores group were associated with older age, higher ISS, and longer hospital stay than lower ICED scores group. Higher ICED group had higher probability of transition-to-death and lower probability of transition-to-discharge under the competing risk model. In the multivariable analysis of transition-specific Cox models, higher ICED group were associated with higher risk for hospital mortality compared to lower ICED group (HR 1.60; [95% CI 1.04–2.47]; p = 0.032). Also, higher ICED group were associated with lower probability of transition-to-discharge (HR 0.79; [95%CI 0.73–0.86]; p < 0.001). Additionally, higher ICED scores accounted for hospital mortality among patients with ISS < 25. In conclusion, our study suggested that severity of comorbidity was associated with higher hospital mortality among traumatized patients, particularly lower ISS.

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“…A prime example of this phenomenon exists among severely injured trauma patients who require prolonged utilization of ICU resources. Advances in early hemorrhage control and physiologic resuscitation strategies for critically ill trauma patients have shifted the frequency distribution of post-injury mortality away from early in-hospital death toward late death ( 4 – 6 ). Septic patients have experienced a similar phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Innate Immunity in the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome and Its Implications for Therapy

et al. 2018

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Clinical and technological advances promoting early hemorrhage control and physiologic resuscitation as well as early diagnosis and optimal treatment of sepsis have significantly decreased in-hospital mortality for many critically ill patient populations. However, a substantial proportion of severe trauma and sepsis survivors will develop protracted organ dysfunction termed chronic critical illness (CCI), defined as ≥14 days requiring intensive care unit (ICU) resources with ongoing organ dysfunction. A subset of CCI patients will develop the persistent inflammation, immunosuppression, and catabolism syndrome (PICS), and these individuals are predisposed to a poor quality of life and indolent death. We propose that CCI and PICS after trauma or sepsis are the result of an inappropriate bone marrow response characterized by the generation of dysfunctional myeloid populations at the expense of lympho- and erythropoiesis. This review describes similarities among CCI/PICS phenotypes in sepsis, cancer, and aging and reviews the role of aberrant myelopoiesis in the pathophysiology of CCI and PICS. In addition, we characterize pathogen recognition, the interface between innate and adaptive immune systems, and therapeutic approaches including immune modulators, gut microbiota support, and nutritional and exercise therapy. Finally, we discuss the future of diagnostic and prognostic approaches guided by machine and deep-learning models trained and validated on big data to identify patients for whom these approaches will yield the greatest benefits. A deeper understanding of the pathophysiology of CCI and PICS and continued investigation into novel therapies harbor the potential to improve the current dismal long-term outcomes for critically ill post-injury and post-infection patients.

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Causes of excessive late death after trauma compared with a matched control cohort

Abstract: Postinjury mortality is increased for several years after trauma. Excess mortality is largely attributed to recurrent trauma and other external causes of death.

Cited by 11 publications

References 32 publications

Risk factors and outcomes of chronic opioid use following trauma

Risk factors and outcomes of chronic opioid use following trauma

Impact of comorbidities on the prognoses of trauma patients: Analysis of a hospital-based trauma registry database

Innate Immunity in the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome and Its Implications for Therapy

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