“Gone viral”: Trauma and hepatitis C

Hepatitis C, a disease of the liver caused by the hepatitis C virus (HCV), can take on both acute and chronic forms—ranging from a mild, self-limited illness where 15 to 45 percent of patients may spontaneously clear the virus, to a serious, lifelong, chronic condition.

An estimated 71 million people around the world have a chronic hepatitis C infection. Chronic infection may lead to cirrhosis in 15 to 30 percent of patients within 20 years and may lead to hepatocellular cancer. Almost 400,000 deaths occur annually worldwide as a result of hepatitis C. Antiviral medication can cure more than 95 percent of individuals with hepatitis C infection, which in turn significantly reduces the risk of death from cirrhosis or cancer. Unfortunately, at present, no vaccine is available to combat this global epidemic.*

How hepatitis C went viral

As a bloodborne pathogen, the most common routes of hepatitis C infection are through exposure to a small quantity of blood. This transmission may occur as the result of needle-sharing in certain high-risk drug user populations, transfusion of unscreened products, exposure to a health care professional who is caring for a patient with hepatitis C, sexual transmission, and from mother to baby.

To examine the occurrence of injured patients with a diagnosis of hepatitis C in the National Trauma Data Bank® (NTDB®) research admission year 2015, medical records were searched using the International Classification of Diseases, Ninth and 10th Revision, Clinical Modification codes. Specifically searched were records that contained either diagnosis codes of 070.41/B17.11 (acute hepatitis C with coma), 070.51/B17.10 (acute hepatitis C without coma), 070.44/070.54/B18.2 (chronic hepatitis C), 070.70/B19.20 (unspecified without coma), or 070.71/B19.21 (unspecified with coma).

A total of 139 records were found, of which 122 records contained a discharge status, including 77 patients discharged to home, 13 to acute care/rehab, and 25 to skilled nursing facilities; seven died (see Figure 1). Of these patients, 73 percent were men, on average 53.5 years of age, had an average hospital length of stay of 7.1 days, an intensive care unit length of stay of 5.1 days, an average injury severity score of 11.0, and were on the ventilator for an average of 6.3 days. Of the 87 patients tested for alcohol, more than one-third were positive.

Figure 1. Hospital discharge status

Figure 1. Hospital discharge status

Precautionary actions

In April, the World Health Organization (WHO) updated its HCV fact sheet, which includes several categories of recommendations regarding HCV infection, including screening high-risk populations, screening for alcohol in patients with documented HCV and offering behavioral reduction strategies, and assessing all adults and children with chronic HCV infection for possible antiviral treatment.

Unfortunately, the worldwide numbers for HCV infection have “gone viral.”  For more information, the WHO HCV fact sheet is available on the World Health Organization’s website.

Throughout the year, we will be highlighting NTDB data through brief monthly reports in the Bulletin. The NTDB Annual Report 2016 is available on the American College of Surgeons website as a PDF file. In addition, information is available regarding how to obtain NTDB data for more detailed study. To submit your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org.

Acknowledgment

Statistical support for this article was provided by Ryan Murphy, Data Analyst, NTDB.


*World Health Organization. Hepatitis C fact sheet. April 2017. Available at: www.who.int/mediacentre/factsheets/fs164/en/. Accessed June 9, 2017.

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