ACUTE AND LONG-TERM OUTCOMES OF EXTREMELY INJURED BLUNT TRAUMA VICTIMS

Long-term outcomes after blunt trauma remain poorly defined, The purpose of this study was to document such outcomes in extremely injured adults (Injury Severity Score greater than or equal to 50), From April 1990 to June 1993, 76 patients (5% of all trauma victims) had an ISS greater than or equal to 50 at a single trauma center, Thirty-five (46%) survived to hospital discharge, The mean duration of hospital stay was longer for survivors than for nonsurvivors (92 days versus 16 days, p < 0.001), Of the 35 survivors, 26% were discharged directly home, 60% to a rehabilitation hospital, 8% to a chronic care facility, and 6% to an acute care hospital, After a mean follow-up of 27 months, 6% had died, 9% refused participation, and the remaining 30 patients (91% of long-term survivors) demonstrated significant residual disabilities in physical, emotional, and mental health status, We suggest that extremely injured patients comprise a small proportion of blunt trauma victims, consume substantial acute care hospital resources, often survive, and yet frequently have residual disability, A reduction in this long-term disability may represent the greatest challenge in modern trauma care.