Open AccessSocioeconomic status and 30-day mortality after minor and major trauma: A retrospective analysis of the Trauma Audit and Research Network (TARN) dataset for England
Author(s) -
Philip McHale,
Daniel Hungerford,
David Taylor-Robinson,
Thomas Lawrence,
Timothy Astles,
Ben Morton
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0210226
Subject(s) - medicine , major trauma , comorbidity , emergency medicine , injury severity score , socioeconomic status , population , injury prevention , poison control , logistic regression , mortality rate , occupational safety and health , audit , demography , medical emergency , environmental health , management , pathology , sociology , economics
Socioeconomic status (SES) is associated with rate and severity of trauma. However, it is unclear whether there is an independent association between SES and mortality after injury. Our aim was to assess the relationship between SES and mortality from trauma. Materials and methods We conducted a secondary analysis of the Trauma Audit and Research Network dataset. Participants were patients admitted to NHS hospitals for trauma between January 2015 and December 2015, and resident in England. Analyses used multivariate logistic regression with thirty-day mortality as the main outcome. Co-variates include SES derived from area-level deprivation, age, injury severity and comorbidity. All analyses were stratified into minor and major trauma. Results There were 48,652 admissions (68% for minor injury, ISS<15) included, and 3,792 deaths. Thirty-day mortality was 10% for patients over 85 with minor trauma, which was higher than major trauma for all age groups under 65. Deprivation was not significantly associated with major trauma mortality. For minor trauma, patients older than 40 had significantly higher aORs than the 0–15 age group. Both the most and second most deprived had significantly higher aORs (1.35 and 1.28 respectively). Conclusions This study provides evidence of an independent relationship between SES and mortality after minor trauma, but not for major trauma. Our results identify that, for less severe trauma, older patients and patients with low SES with have an increased risk of 30-day mortality. Policy makers and service providers should consider extending the provision of ‘major trauma’ healthcare delivery to this at-risk population.