Diabetes as a contributor to traumatic injuries and associated in-hospital complications: A retrospective study

Abstract

Background

Despite the growing recognition of the interplay between diabetes and trauma outcomes, there remains a paucity of research. This study aims to describe the burden of diabetes in people with traumatic injuries, quantify its association with the occurrence of injuries and in-hospital outcomes in New Zealand (NZ), to inform the development of clinical decision support tools.

Methods

A retrospective review of Te Manawa Taki (TMT) trauma registry of all injury severities linked to the national minimum data set of NZ over 2014–2023 was conducted. Pre-existing diabetes was identified by ICD-10-AM codes E10, E11, E13 and E14 at the time of trauma admission, and complications were defined using the Australia and New Zealand Trauma Registry classification.

Results

Over the period 2014–2023, there were 2196 cases of trauma (3.9%) with pre-existing diabetes. They faced 172% higher odds of being injured from falls compared to non-diabetics (odds ratio) = 2.7(95% CI: 2.5–3.0), p < 0.001. Diabetes, with or without complications, is strongly associated with acute kidney injury and pressure ulcers (p < 0.001). In addition, diabetes with complications was associated with other in-hospital complications, including catheter-associated urinary-tract infection, central line-associated bloodstream infection, sepsis, deep surgical site infection and stroke (p < 0.01).

Conclusion

The findings underscore that the presence of diabetes in trauma patients is not rare, and complications arise across injury severities. From a clinical perspective, the evidence base is strong enough to support using diabetes presence as a key variable in predictive models and as a trigger for proactive referral to diabetes services. More research is needed to improve diabetes screening and key physiologic parameters in trauma settings to guide early management decisions.