Midwest Surgical AssociationContinued rationale of why hospital mortality is not an appropriate measure of trauma outcomes
Section snippets
Methods
This study is a retrospective chart review of all adult patients consecutively admitted to the trauma service at a regional level 1 trauma center over a 3-year period from January 2007 to December 2009. All patients who died during their admission to the trauma service were identified, and data were collected including patient age, sex, race, insurance status, injury severity score, ICU length of stay, whether or not death occurred after WOC, the primary attending on service in the trauma ICU
Patient characteristics
A total of 6,494 adult patients were admitted to the trauma service of our level 1 regional trauma center over the 3-year study period. The mortality rate over this time period was 3.3%. Of the 216 patients who died during their hospital stay, the mean age and Injury Severity Score (ISS) were 55 and 30, respectively. Patient characteristics and demographics are shown in Table 1.
Evaluation of withdrawal practices
Care was withdrawn before 104 of the 216 (48%) deaths in this study. Despite a high incidence of WOC overall, we found
Comments
In this study, 48% of the study population died after WOC. Previous studies have shown WOC rates in the trauma population range from 40% to 80%.6, 7, 8 This range highlights the lack of standardized withdrawal practices between institutions. Within our own trauma ICU, there was a perceived difference in how often individual trauma intensivists participated in the discussion, decision, and act of withdrawing care from our critically ill trauma patients. We show here that this perceived
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Cited by (8)
Quantifying the burden of pre-existing conditions in older trauma patients: A novel metric based on mortality risk
2019, American Journal of Emergency MedicineCitation Excerpt :Our PEC Risk Score was developed using an outcome which combined in-hospital death and death within 90 days of discharge. Incorporation of deaths during the 90-day post-discharge period sought to address a significant bias associated with misclassifying survivorship due to a loss-to-follow-up such as discharge [10,48,49], and was selected based on previous work which indicated that trauma influenced mortality up to 90 days after discharge [12,29]. Nearly three times as many patients died within 90 days of discharge as did in-hospital.
Big Data and Clinical Research in Traumatic Brain Injury
2018, World NeurosurgeryThe differential associations of preexisting conditions with trauma-related outcomes in the presence of competing risks
2016, InjuryCitation Excerpt :Outcomes research is often focused on the evaluation of death at the time of discharge as the primary indicator of quality of care. Recent research suggests that mortality risk remains high in patients discharged to care facilities [10–13]. The discharge of a high-risk patient, in effect, acts as a competing risk event to in-hospital mortality which is formally defined as any event that prevents the observation of the event of interest or modifies the chance that the event occurs [14].
Quality of trauma care and trauma registries
2015, Medicina IntensivaAre all deaths recorded equally? the impact of hospice care on risk-adjusted mortality
2014, Journal of Trauma and Acute Care Surgery