Author Affiliations: Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran (Dr Rahimi-Movaghar) (email@example.com); Department of Orthopedics, Rothman Institute, Philadelphia, Pennsylvania (Dr Rasouli); and Department of Orthopedics, Thomas Jefferson University, Philadelphia (Dr Vaccaro).
To the Editor: Certain factors may limit the conclusions of the study by Dr Davidson and colleagues.1 The authors stated that discharge to a skilled nursing facility was an independent predictor of long-term mortality in all age groups. Although the authors controlled for confounders, we believe that the need for discharge to a skilled nursing facility reflects either severe primary injury or less-severe injury in patients who need complex medical management—often elderly individuals or those with underlying comorbidities. Thus, discharge to a skilled nursing facility may not be the only important independent predictor of long-term mortality in trauma patients.
Rahimi-Movaghar V, Rasouli MR, Vaccaro AR. Trauma and Long-term Mortality. JAMA. 2011;305(23):2413-2414. doi:10.1001/jama.2011.785