M. J. Kao1, H. Nunez1, A. H. Stephen1, S. F. Monaghan1, S. N. Lueckel1, D. J. Heffernan1, C. A. Adams1, W. G. Cioffi1 1Alpert Medical School Of Brown University, Rhode Island Hospital,Division Of Trauma And Surgical Critical Care, Department Of Surgery,Providence, RI, USA
Introduction: Although trauma is an illness that occurs in an acute fashion, often demanding immediate attention, significant numbers of trauma patients present to the hospital hours or days after their initial injury. Delays in presentation occur for a variety of reasons such as lack of awareness of the consequences of injury or limited access to healthcare. Such delays are often associated with increasingly complex disease patterns and management options. There has been little investigation into whether there are differences in trauma patients who present delayed compared to patients that present immediately after injury. We hypothesize that trauma patients who present delayed have different demographic characteristics, comorbidities, and may be at increased risk for worse outcomes.
Methods: This is a retrospective review of the trauma registry from 2010-2014 at a Level I trauma center. Patients admitted to the trauma service were categorized as delayed if they presented greater than 24 hours after their initial injury. All patients admitted to the trauma service within 24 hours of their initial injury served as the control group. Charts were reviewed for demographics, mechanism of injury, comorbidities, hospital course and complications and outcomes. Continuous data was analyzed with Student’s t test and categorical data with Chi squared technique.
Results: During the five-year period, 11,705 patients were admitted of whom 588 patients (5%) presented greater than 24 hours after their initial injury. Patients in the delayed presentation group were older (65 vs. 55 years, p<0.001) and more likely to have psychiatric (33% vs. 24%, p = 0.0001) or endocrine comorbidities (27% vs. 23%, p = 0.04) than the control group. ISS in the delayed group was slightly lower (9 vs 10, p=0.003). In the delayed group, the average presenting time was 4.9 days after injury and there were a higher percentage of burns (7.1% vs. 2.8%, p<0.001) and falls (76.4% vs. 49.3%, p<0.001). Patients in the delayed group had shorter ICU length of stay (1.29 vs. 1.79 days, p = 0.03) but were more likely to suffer from alcohol withdrawal during their hospital stay (8.9% vs. 4.1%, p<0.001).
Conclusion: Trauma patients who presented to the hospital in a delayed fashion after their initial injury were older and had different patterns of injury with more burns and falls. They also had more psychiatric comorbidities and were more likely to suffer negative outcomes such as alcohol withdrawal. It is important to identify these patients so they can receive more timely and focused care as it pertains to prevention of alcohol withdrawal. Future goals will include exploring strategies for early intervention, such as automatic alcohol withdrawal monitoring and social work referral for all patients who present in a delayed fashion.