Outcomes of trauma patients depend heavily on whether recommended practices are followed
Research Activities, August 2012, No. 384
Traumatic injuries place patients at increased risk for death and disability, not to mention the high costs associated with the high-tech care these individuals receive. Traumatic injuries represent the fifth most common cause of death overall in the United States and the leading cause of death in those younger than 45 years old. A set of quality indicators for trauma care has been developed by the American College of Surgeons. In a recent study, researchers found a direct correlation between these best practices of care and patient outcomes. Better performance on six quality indicators was associated with lower rates of mortality or major complications.
For example, not performing surgery on abdominal gunshot wounds was associated with a five-fold increase in mortality. Patients with head trauma who did not receive a computerized tomographic scan had a four-fold increase in mortality and a three-fold increase in major complications. Patients with femoral fractures who did not have fixation were also found to have significant increases in mortality and major complications. Interestingly, the researchers found that 40 percent of patients transported to the hospital by air or ground ambulance had a missing ambulance record. Another 28 percent of patients had missing emergency department hourly documentation of vital signs. However, there was no association found between incomplete documentation and worse outcomes.
These findings were based on analysis of data on 210,942 patients who were admitted to 35 trauma centers in Pennsylvania between 2000 and 2009. Blunt trauma, motor vehicle collisions, and low falls were the three leading causes of injury. Overall, the mortality rate was 6.3 percent and the major complication rate was 7.2 percent. The study was supported by the Agency for Healthcare Research and Quality (HS16737).
See "Association between trauma quality indicators and outcomes for injured patients," by Laurent G. Glance, M.D., Andrew W. Dick, Ph.D., Dana B. Mukamel, Ph.D., and Turner M. Osler, M.D., in the April 2012 Archives of Surgery 147(4), pp. 308-315.