Complications increase mortality of trauma patients
Research Activities, August 2012, No. 384
Trauma patients admitted to the hospital frequently have complications that contribute to morbidity and mortality. In a study of 409,393 trauma patients admitted to 159 California hospitals between 2004 and 2008, researchers identified 175,299 complications as contributing significantly to the deaths of these patients. Complications fell into 82 separate categories or conditions as defined by the International Classification of Diseases (ICD-9) and ranged from hyperosmolarity (increased concentration of bodily fluids, as in dehydration) to ventricular fibrillation (irregular heart beat).
Most complication-related mortality was due to 25 individual conditions. Each additional complication experienced by a patient increased mortality by 8 percent. If no complications had occurred, there would have been 7,292 fewer deaths, a 64 percent reduction in mortality.
A complication was defined as any ICD-9 code that accrued after hospital admission. A single complication (respiratory arrest) accounted for 9 percent of attributable deaths and only 8 complications accounted for 50 percent of the attributable deaths. On average, each patient experienced 0.4 complications, with 24 percent of patients experiencing 1 or more complications.
The researchers believe that they have derived the first empirical list of complications for trauma patients. They recommend that clinicians target complications linked to the greatest number of deaths, perhaps with specific clinical protocols, to avert the greatest number of fatalities. This study was supported by a grant from the Agency for Healthcare Research and Quality (HS16737).
See "Complication-associated mortality following trauma. A population-based observational study," by Turner Osler, M.D., Laurent G. Glance, M.D., and David W. Hosmer, Ph.D. in the Archives of Surgery 147(2), pp. 152-158, 2012.