Trauma patients are more likely to die after a major complication in high-mortality hospitals
Research Activities, December 2011, No. 376
Patients hospitalized for trauma can die after a major complication. This is called "failure-to-rescue." A new study concludes that failure-to-rescue is a primary driver of differences in the hospital outcomes of trauma patients. It found that hospitals with higher trauma mortality rates had higher failure-to-rescue rates than low-mortality hospitals.
Researchers analyzed 54,713 patient records from the National Trauma Databank in 2007. They categorized hospitals as low-, average-, and high-mortality institutions. Hospital quality was determined based on the incidence of mortality among trauma patients. Adjustments were made for injury severity, trauma mechanism, and patient physiology. The two most common trauma mechanisms were blunt trauma and motor vehicle accidents. However, patients in high-mortality hospitals were more likely to have experienced a gunshot wound compared to patients at low-mortality hospitals.
The study's findings suggest that the primary driver of differences in hospital quality for trauma patients is failure-to-rescue as opposed to differences in complication rates. Patients in low-mortality hospitals had similar rates of major complications compared to patients in hospitals with high mortality rates. On the other hand, patients in low-mortality hospitals were significantly less likely to die after major complications compared to patients in high-mortality hospitals. The study was supported by the Agency for Healthcare Research and Quality (HS16737).
See "Variation in hospital complication rates and failure-to-rescue for trauma patients," by Laurent G. Glance, M.D., Andrew W. Dick, Ph.D., J. Wayne Meredith, M.D., and Dana B Mukamel, Ph.D., in the April 2011 Annals of Surgery 253(4), pp. 811-816.