@article{ref1,
title="Deaths and high-risk trauma patients missed by standard trauma data sources",
journal="Journal of trauma and acute care surgery",
year="2017",
author="Newgard, Craig D. and Fu, Rochelle and Lerner, E. Brooke and Daya, Mohamud and Wright, Dagan and Jui, Jonathan and Mann, N. Clay and Bulger, Eileen and Hedges, Jerris and Wittwer, Lynn and Lehrfeld, David and Rea, Thomas",
volume="83",
number="3",
pages="427-437",
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. <br><br>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. <br><br>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).<br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="2163-0755",
doi="10.1097/TA.0000000000001616",
url="http://dx.doi.org/10.1097/TA.0000000000001616"
}