Citation

Newgard CD, Fu R, Lerner EB, Daya M, Wright D, Jui J, Mann NC, Bulger E, Hedges J, Wittwer L, Lehrfeld D, Rea T. J. Trauma Acute Care Surg. 2017; 83(3): 427-437.

Affiliation

1Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon 2Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon 3Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 4Tualatin Valley Fire & Rescue, Tualatin, Oregon 5Injury and Violence Prevention Section, Oregon Health Authority, Portland, Oregon 6Emergency Medical Services & Trauma Systems, Oregon Health Authority, Portland, Oregon 7Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon 8Multnomah County Emergency Medical Services, Portland, Oregon 9Intermountain Injury Control Research Center, Department of Pediatrics, University of Utah, Salt Lake City, Utah 10Department of Surgery, University of Washington, Seattle, Washington 11Department of Medicine, John A. Burns School of Medicine, University of Hawaii-Manoa, Honolulu, Hawaii, USA 12Clark Regional Emergency Services Agency, Vancouver, Washington 13PeaceHealth Southwest Medical Center, Vancouver, Washington 14Department of Internal Medicine, University of Washington 15King County Emergency Medical Services, Seattle, Washington.

Copyright

(Copyright © 2017, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001616

PMID

28598904

Abstract

BACKGROUND: Trauma registries are used to evaluate and improve trauma care, yet potentially miss certain trauma deaths and high-risk patients. We estimated the number of missed deaths and high-risk trauma patients using commonly-available sources of trauma data, and bias in quality metrics for field trauma triage.

METHODS: This was a pre-planned secondary analysis of a population-based prospective cohort of injured patients transported by 44 EMS agencies to 28 hospitals in 7 Northwest counties from 1/1/2011 to 12/31/2011 and followed through hospitalization. We used a stratified probability sampling design for 17,633 patients, weighted to represent all 53,487 injured patients transported by EMS. We compared patients meeting National Trauma Data Bank (NTDB) criteria (weighted n = 5,883), all injured patients presenting to major trauma centers (weighted n = 16,859) and all admitted patients (weighted n = 18,433), to the full sample. Outcomes included in-hospital mortality, Injury Severity Score (ISS) ≥ 16 and critical resource use within 24 hours.

RESULTS: Among 53,487 injured patients, there were 520 ED and in-hospital deaths, 1,745 with ISS ≥ 16 and 923 requiring early critical resources. Compared to the full cohort, the NTDB cohort missed 62.1% of deaths, 39.2% of patients with ISS ≥ 16 and 23.8% requiring early critical resources, especially older adults injured by falls and admitted to non-trauma hospitals. The admission cohort missed the fewest patients - 23.3% of deaths, 10.5% with ISS ≥ 16 and 13.1% requiring early resources. Compared to triage sensitivity in the full cohort (66.2%), sensitivity estimates ranged from 63.6% (all admissions) to 93.4% (NTDB). For triage specificity in the full cohort (87.8%), estimates ranged from 36.4% (NTDB) to 77.3% (all admissions).

CONCLUSIONS and RelevanceCommon sources of trauma data miss substantial numbers of deaths and high-risk trauma patients and can generate biased estimates for trauma system quality metrics. LEVEL OF EVIDENCE: Level III evidence. Prospective cohort study - epidemiologic/prognostic.

Language: en