Injury severity-based discrepancies in severe trauma survival improvement.

Area of Science:

• Trauma Surgery
• Public Health
• Epidemiology

Background:

• Trauma registries capture most at-risk patients, but milder injuries often outnumber critical ones.
• Overall outcome trends may mask disparities in outcomes for severely injured patients.
• Investigating trends in the highest injury severity group is crucial for understanding true mortality changes.

Purpose of the Study:

• To examine contemporary trends in reducing in-hospital mortality for the highest injury severity patient group.
• To test the hypothesis that mortality improvements are similar across all trauma patients in a state registry.
• To identify if overall mortality improvements mask stagnation or worsening in critically injured populations.

Main Methods:

• Analysis of 27,862 patients with Injury Severity Score (ISS) 13-75 over 10 years (ending 2021) from a state trauma registry.
• Patients divided into ISS groups: 13-39 and 40-75.
• Further subgroup analysis of the 40-75 group into 40-49, 50-74, and 75 for detailed outcome assessment.

Main Results:

• Overall in-hospital mortality significantly decreased over the study period (OR: 0.976).
• Mortality for the highest injury severity group (ISS 40-75) showed no significant change (OR: 1.005).
• Subgroup analysis revealed worsening mortality for ISS 40-49 (OR: 1.079), improved mortality for ISS 50-74 (OR: 0.913), and no change for ISS 75 (OR: 1.049).

Conclusions:

• Overall mortality improvements in severely injured patients do not apply to the most critically injured.
• The highest injury severity patient group is not homogenous regarding mortality trends.
• The ISS 40-49 population requires targeted quality improvement efforts to address worsening outcomes.