Deaths and High-Risk Trauma Patients Missed By Standard Trauma Data Sources

Craig Newgard, Rongwei (Rochelle) Fu, Brooke B. Lerner, Mohamud Ramzan Daya, Dagan Wright, Jonathan Jui, Clay C. Mann, Eileen Bulger, Jerris Hedges, Lynn Wittwer, David Lehrfeld, Thomas Rea

Research output: Contribution to journalArticle

10 Citations (Scopus)

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. 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. 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).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.

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - Jun 9 2017

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Information Storage and Retrieval
Wounds and Injuries
Injury Severity Score
Triage
Databases
Metric System
Trauma Centers
Hospital Mortality
Registries
Hospitalization
Cohort Studies

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Deaths and High-Risk Trauma Patients Missed By Standard Trauma Data Sources. / Newgard, Craig; Fu, Rongwei (Rochelle); Lerner, Brooke B.; Daya, Mohamud Ramzan; Wright, Dagan; Jui, Jonathan; Mann, Clay C.; Bulger, Eileen; Hedges, Jerris; Wittwer, Lynn; Lehrfeld, David; Rea, Thomas.

In: Journal of Trauma and Acute Care Surgery, 09.06.2017.

Research output: Contribution to journalArticle

Newgard, Craig ; Fu, Rongwei (Rochelle) ; Lerner, Brooke B. ; Daya, Mohamud Ramzan ; Wright, Dagan ; Jui, Jonathan ; Mann, Clay C. ; Bulger, Eileen ; Hedges, Jerris ; Wittwer, Lynn ; Lehrfeld, David ; Rea, Thomas. / Deaths and High-Risk Trauma Patients Missed By Standard Trauma Data Sources. In: Journal of Trauma and Acute Care Surgery. 2017.
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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. 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. 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).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.",
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AU - Newgard, Craig

AU - Fu, Rongwei (Rochelle)

AU - Lerner, Brooke B.

AU - Daya, Mohamud Ramzan

AU - Wright, Dagan

AU - Jui, Jonathan

AU - Mann, Clay C.

AU - Bulger, Eileen

AU - Hedges, Jerris

AU - Wittwer, Lynn

AU - Lehrfeld, David

AU - Rea, Thomas

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N2 - 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. 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. 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).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.

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