Citation

Jenkins PC, Richardson CR, Norton EC, Cooke CR, Banerjee M, Nathens AB, Hemmila MR. J. Am. Coll. Surg. 2015; 221(3): 729-738.e1.

Affiliation

Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI.

Copyright

(Copyright © 2015, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2015.05.016

PMID

26232304

Abstract

BACKGROUND: Increases in trauma patient volume and acuity, such as during mass casualty events, can overwhelm hospitals, potentially worsening patient outcomes. Due to methodological limitations, the effect of trauma surges on clinical outcomes remains unclear, so hospitals have not prepared for such events in an evidence-based manner. The objective of this study was to develop a new measure of hospital capacity strain corresponding to trauma admissions and to examine the relationship between trauma surges and inpatient mortality. STUDY DESIGN: Using trauma registry data from hospitals across the United States and Canada (2010 to 2011), we developed the Trauma Surge Index (TSI), a measure of capacity strain that controls for variation in hospital admission volume and patient acuity. Using the TSI and an established definition of mass casualty events, we quantified hospital surges and entered each measure as an exposure variable in separate risk-adjusted mortality models.

RESULTS: Using the TSI method, we observed that patients admitted during high-surge periods display significantly increased mortality compared with patients admitted during low-surge periods (odds ratio = 2.05; 95% CI, 1.36-3.10), and patients with firearms injuries were particularly at risk (odds ratio = 7.29; 95% CI, 2.13-24.91). Using mass casualty event criteria, we found no difference between the mortality of patients admitted during trauma surges and nonsurge periods (odds ratio = 0.94; 95% CI, 0.88-1.01).

CONCLUSIONS: We demonstrate the TSI, which is a novel method that identified periods of high-capacity strain in hospitals associated with increased trauma patient mortality. Our newly developed TSI method can be implemented by hospitals and trauma systems to examine periods of high-capacity strain retrospectively, identify specific resources that might have been needed, and better direct future investments in an evidence-based manner.

Language: en