Excess mortality caused by medical injury

Linda N. Meurer, Hongyan Yang, Clare E. Guse, Carla Russo, Karen Brasel, Peter M. Layde

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

PURPOSE: We wanted to estimate excess risk of in-hospital mortality associated with medical injuries identified using an injury surveillance system, after controlling for risk of death resulting from comorbidities. METHODS: The Wisconsin Medical Injuries Prevention Program (WMIPP) screening criteria were used to identify medical injuries, defined as "any untoward harm associated with a therapeutic or diagnostic healthcare intervention," among discharge diagnoses for all 562,317 patients discharged from 134 acute care hospitals in Wisconsin in 2002. We then derived estimates for crude and adjusted relative risk of in-hospital mortality associated with the presence of a medical injury diagnosis. Logistic regression adjusted for baseline risk of mortality using a comorbidity index, age, sex, Diagnosis Related Groups, hospital characteristics, and clustering within hospital. RESULTS: There were 77,666 discharges that met WMIPP criteria for at least 1 medical injury (13.8%). Crude risk ratios for death ranged from 1.27 to 2.4 for those with medical injuries within 1 of 4 categories: drugs/biologics; devices, implants, and grafts; procedures; and radiation. After adjustment, estimates of excess mortality decreased, and significance persisted only for injuries related to procedures (39%; 95% confidence interval [CI], 28%-52%) and devices, implants, and grafts (16%; 95% CI, 3%-30%). CONCLUSIONS: Estimates of excess mortality that do not account for baseline mortality risk may be exaggerated. Findings have implications for the care family physicians provide in the hospital and for the advice they give their patients who are concerned about the risks of hospitalization.

Original languageEnglish (US)
Pages (from-to)410-416
Number of pages7
JournalAnnals of Family Medicine
Volume4
Issue number5
DOIs
StatePublished - Sep 2006
Externally publishedYes

Fingerprint

Mortality
Wounds and Injuries
Hospital Mortality
Comorbidity
Confidence Intervals
Transplants
Equipment and Supplies
Diagnosis-Related Groups
Family Physicians
Biological Products
Cluster Analysis
Hospitalization
Logistic Models
Odds Ratio
Radiation
Delivery of Health Care
Pharmaceutical Preparations
Therapeutics

Keywords

  • Adverse effects
  • Comorbidity
  • Hospital mortality
  • Iatrogenic disease
  • Medical errors
  • Medication errors
  • Postoperative complications
  • Quality of health care
  • Research methods
  • Safety, medical device

ASJC Scopus subject areas

  • Family Practice

Cite this

Meurer, L. N., Yang, H., Guse, C. E., Russo, C., Brasel, K., & Layde, P. M. (2006). Excess mortality caused by medical injury. Annals of Family Medicine, 4(5), 410-416. https://doi.org/10.1370/afm.553

Excess mortality caused by medical injury. / Meurer, Linda N.; Yang, Hongyan; Guse, Clare E.; Russo, Carla; Brasel, Karen; Layde, Peter M.

In: Annals of Family Medicine, Vol. 4, No. 5, 09.2006, p. 410-416.

Research output: Contribution to journalArticle

Meurer, LN, Yang, H, Guse, CE, Russo, C, Brasel, K & Layde, PM 2006, 'Excess mortality caused by medical injury', Annals of Family Medicine, vol. 4, no. 5, pp. 410-416. https://doi.org/10.1370/afm.553
Meurer LN, Yang H, Guse CE, Russo C, Brasel K, Layde PM. Excess mortality caused by medical injury. Annals of Family Medicine. 2006 Sep;4(5):410-416. https://doi.org/10.1370/afm.553
Meurer, Linda N. ; Yang, Hongyan ; Guse, Clare E. ; Russo, Carla ; Brasel, Karen ; Layde, Peter M. / Excess mortality caused by medical injury. In: Annals of Family Medicine. 2006 ; Vol. 4, No. 5. pp. 410-416.
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AB - PURPOSE: We wanted to estimate excess risk of in-hospital mortality associated with medical injuries identified using an injury surveillance system, after controlling for risk of death resulting from comorbidities. METHODS: The Wisconsin Medical Injuries Prevention Program (WMIPP) screening criteria were used to identify medical injuries, defined as "any untoward harm associated with a therapeutic or diagnostic healthcare intervention," among discharge diagnoses for all 562,317 patients discharged from 134 acute care hospitals in Wisconsin in 2002. We then derived estimates for crude and adjusted relative risk of in-hospital mortality associated with the presence of a medical injury diagnosis. Logistic regression adjusted for baseline risk of mortality using a comorbidity index, age, sex, Diagnosis Related Groups, hospital characteristics, and clustering within hospital. RESULTS: There were 77,666 discharges that met WMIPP criteria for at least 1 medical injury (13.8%). Crude risk ratios for death ranged from 1.27 to 2.4 for those with medical injuries within 1 of 4 categories: drugs/biologics; devices, implants, and grafts; procedures; and radiation. After adjustment, estimates of excess mortality decreased, and significance persisted only for injuries related to procedures (39%; 95% confidence interval [CI], 28%-52%) and devices, implants, and grafts (16%; 95% CI, 3%-30%). CONCLUSIONS: Estimates of excess mortality that do not account for baseline mortality risk may be exaggerated. Findings have implications for the care family physicians provide in the hospital and for the advice they give their patients who are concerned about the risks of hospitalization.

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