BACKGROUND: The goal of this study was to examine the association between patient complications and admission to Level I trauma centers (TC) compared with nontrauma centers (NTC). STUDY DESIGN: This was a retrospective cohort study of data derived from the National Study on the Costs and Outcomes of Trauma (NSCOT). Patients were recruited from 18 Level I TCs and 51 NTCs in 15 regions encompassing 14 states. Trained study nurses, using standardized forms, abstracted the medical records of the patients. The overall number of complications per patient was identified, as was the presence or absence of 13 specific complications. RESULTS: Patients treated in TCs were more likely to have any complication compared with patients in NTCs, with an adjusted relative risk (RR) of 1.34 (95% CI, 1.03, 1.74). For individual complications, only the urinary tract infection RR of 1.94 (95% CI, 1.07, 3.17) was significantly higher in TCs. TC patients were more likely to have 3 or more complications (RR, 1.83; 95% CI, 1.16, 2.90). Treatment variables that are surrogates for markers of injury severity, such as use of pulmonary artery catheters, multiple operations, massive transfusions (> 2,500 mL packed red blood cells), and invasive brain catheters, occurred significantly more often in TCs. CONCLUSIONS: Trauma centers have a slightly higher incidence rate of complications, even after adjusting for patient case mix. Aggressive treatment may account for a significant portion of TC-associated complications. Pulmonary artery catheter use and intubation had the most influence on overall TC complication rates. Additional study is needed to provide accurate benchmark measures of complication rates and to determine their causes.
BACKGROUND: The goal of this study was to examine the association between patient complications and admission to Level I trauma centers (TC) compared with nontrauma centers (NTC). STUDY DESIGN: This was a retrospective cohort study of data derived from the National Study on the Costs and Outcomes of Trauma (NSCOT). Patients were recruited from 18 Level I TCs and 51 NTCs in 15 regions encompassing 14 states. Trained study nurses, using standardized forms, abstracted the medical records of the patients. The overall number of complications per patient was identified, as was the presence or absence of 13 specific complications. RESULTS:Patients treated in TCs were more likely to have any complication compared with patients in NTCs, with an adjusted relative risk (RR) of 1.34 (95% CI, 1.03, 1.74). For individual complications, only the urinary tract infection RR of 1.94 (95% CI, 1.07, 3.17) was significantly higher in TCs. TC patients were more likely to have 3 or more complications (RR, 1.83; 95% CI, 1.16, 2.90). Treatment variables that are surrogates for markers of injury severity, such as use of pulmonary artery catheters, multiple operations, massive transfusions (> 2,500 mL packed red blood cells), and invasive brain catheters, occurred significantly more often in TCs. CONCLUSIONS:Trauma centers have a slightly higher incidence rate of complications, even after adjusting for patient case mix. Aggressive treatment may account for a significant portion of TC-associated complications. Pulmonary artery catheter use and intubation had the most influence on overall TC complication rates. Additional study is needed to provide accurate benchmark measures of complication rates and to determine their causes.
Authors: James Dean Sandham; Russell Douglas Hull; Rollin Frederick Brant; Linda Knox; Graham Frederick Pineo; Christopher J Doig; Denny P Laporta; Sidney Viner; Louise Passerini; Hugh Devitt; Ann Kirby; Michael Jacka Journal: N Engl J Med Date: 2003-01-02 Impact factor: 91.245
Authors: Ellen J MacKenzie; David B Hoyt; John C Sacra; Gregory J Jurkovich; Anthony R Carlini; Sandra D Teitelbaum; Harry Teter Journal: JAMA Date: 2003-03-26 Impact factor: 56.272
Authors: Elliott R Haut; David C Chang; Charles A Pierce; Elizabeth Colantuoni; David T Efron; Adil H Haider; Edward E Cornwell; Peter J Pronovost Journal: J Trauma Date: 2009-04
Authors: Mitchell M Levy; John Rapoport; Stanley Lemeshow; Donald B Chalfin; Gary Phillips; Marion Danis Journal: Ann Intern Med Date: 2008-06-03 Impact factor: 25.391
Authors: Brian R Englum; Xuan Hui; Cheryl K Zogg; Muhammad Ali Chaudhary; Cassandra Villegas; Oluwaseyi B Bolorunduro; Kent A Stevens; Elliott R Haut; Edward E Cornwell; David T Efron; Adil H Haider Journal: Am Surg Date: 2016-03 Impact factor: 0.688