In-hospital and 30-day mortality excludes non-survivors who die after these time periods in other facilities and out with hospital, overestimating survival.

30 days is a common survival outcome measure for trauma performance analysis, but it is not reflective of the true burden of trauma on society; functional status post-injury and mortality after 30 days are inadequately reported within current literature.

There is a significant long-lasting mortality attributable to trauma with over 97 % of trauma and trauma-contributed deaths in our sample occurring within 6 months of injury.

Post-discharge deaths represent a crucial, often neglected, percentage of trauma deaths with over 28 % deaths in our sample occurring after discharge from acute care.

Our novel approach to data linkage between trauma registries and certified cause of death addresses the challenges faced with acquiring accurate trauma mortality statistics.

Few studies effectively quantify the long-term incidence of death following injury.

The absence of detailed mortality and underlying cause of death data results in limited understanding and a potential underestimation of the consequences at a population level. This study takes a nationwide approach to identify the one-year mortality following injury in Scotland, evaluating survivorship in relation to pre-existing comorbidities and incidental causes of death.

This retrospective cohort study assessed the one-year mortality of adult trauma patients with an Injury Severity Score ≥ 9 during 2020 using the Scottish Trauma Audit Group (STAG) registry linked to inpatient hospital data and death certificate records. Patients were divided into three groups: trauma death, trauma-contributed death, and non-trauma death. Kaplan-Meier curves were used for survival analysis to evaluate mortality, and cox proportional hazards regression analysed risk factors linked to death.

4056 patients were analysed with a median age 63 years (58–88) and male predominance (55.2 %). Falls accounted for 73.1 % of injuries followed by motor vehicle accidents (16.3 %) and blunt force (4.9 %). Extremity was the most commonly injured region overall followed by chest and head. However, head injury prevailed in those who died. The registry demonstrated a one-year mortality of 19.3 % with 55 % deaths occurring post-discharge. Of all deaths reported, 35.3 % were trauma deaths, and 47.7 % were trauma-contributed deaths. These groups accounted for over 70 % of mortality within 30 days of hospital admission and continued to represent the majority of deaths up to 6 months post-injury. Patients who died after 6 months were mainly the result of non-traumatic causes, frequently circulatory, neoplastic, and respiratory diseases (37.7 %, 12.3 %, 9.1 %, respectively). Independent risk factors for one-year mortality included a GCS ≤ 8, modified Charlson Comorbidity score >5, Injury Severity Score >25, serious head injury, age and sex.

With a one-year mortality of 19.3 %, and post-discharge deaths higher than previously appreciated, patients can face an extended period of survival uncertainty.

As mortality due to index trauma lasted up to 6 months post-admission, short-term outcomes fail to represent trauma burden and so cogent survival predictions should be avoided in clinical and patient settings.

Trauma registry

Severe injury

Trauma

Major trauma

Mortality

1-year mortality

Outcome

Cause of death

Injury severity score

Injury

Multiple injuries

© 2024 The Authors. Published by Elsevier Ltd.