How traumatic injury has become a health care crisis

Traumatic injury, or sudden physical injury requiring immediate medical attention, is an epidemic in the United States. It affects individuals of all ages, races and societal classes and accounts for over 41 million emergency department visits and 2.3 million hospital admissions each year.

Additionally, 214,000 people die yearly from traumatic injury, including things such as falls, car crashes and violence. That is one person every three minutes. Trauma is the leading cause of death for individuals from 1 to 46 years and the fourth leading cause of death for all age groups. Traumatic injury affects our schoolchildren, your grandparents, our troops – no one is safe.

The staggering death toll is only a superficial assessment of the impact that traumatic injury has on our society. For every trauma victim who dies, many more survivors face lifelong physical, mental and financial challenges. Compared to a decade ago, trauma victims requiring hospitalization are increasingly older, more severely injured and have multiple other diseases, which complicates their medical care. Together, fatal and nonfatal injury cost society over US$671 billion annually.

As physicians who treat trauma patients, we see the substantial impact that traumatic injury has on individual victims, their families and society. As medical researchers, we understand that more research needs to be directed at improving the lifelong challenges associated with traumatic injury.

Big gains, but not enough

Falls are the leading cause of accidental death in people 65 and older. Toa55/Shutterstock.com
In 1966, the National Academy of Sciences recognized the massive societal burden of traumatic injury and released a report detailing the extent of unintentional, or traumatic, injury in the U.S. This report provided recommendations for the development of pre-hospital care, trauma systems, patient registries and injury research.

A decade later, the American College of Surgeons Committee on Trauma developed guidelines that set treatment standards for local and regional trauma centers. These initiatives have led to remarkable improvements in 30-day or in-hospital trauma mortality rates. Additionally, safer automobiles with airbags, legal alcohol limit reduction and movements such as Stop the Bleed have all led to improvements in immediate trauma survival. In 2003, in-hospital mortality rates were 22%; today mortality rates average less than 4%.

However, the worrisome fact is that we still do not know what factors contribute to long-term mortality following trauma. When trauma victims are followed past hospital discharge, studies show that mortality rates increase at an alarming rate, reaching 16% at three years.

Elderly people appear to be especially vulnerable, such as former Pres. Jimmy Carter, who suffered a broken hip from a fall on May 13, 2019. For example, in 2013 alone, 2.5 million older adults sustained injuries due to falls. Over 800,000 of these patients were hospitalized, most often due to a traumatic brain injury or a hip fracture.

Elderly patients who sustain a hip fracture have an estimated one-year mortality as high as 58%. This implies that although injured trauma patients may live to leave the hospital, they remain at increased risk of long-term mortality following their initial injuries. Therefore, the medical community should view traumatic injury not just as single incident in time but as a debilitating chronic disease that has long-term consequences.

Reasons for increased mortality unclear

One-year mortality rates for falls remain high. Trauma experts believe more research could yield answers. VGStockstudio/Shutterstock.com
Especially concerning for those of us who treat and study trauma, is that we can only speculate the reasons behind this increased long-term mortality. Trauma registries, or systems that collect information following traumatic injuries, currently lack data on both long-term survival and functional outcomes after discharge from the hospital. This lack of data hinders our ability to understand why trauma victims die after leaving the hospital.

Medical research works to reduce both the risk and burden of human disease. Unfortunately, research funding aimed at improving traumatic injury outcomes is lacking compared to other public health concerns.