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Nine-year change of mortality and discharge against medical advice among major trauma patients in a Chinese Intensive Care Unit

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

The mortality/morbidity of patients can be used to evaluate the quality of a trauma care, which can be influenced by incidence of discharge against medical advice (DAMA).

Objective

This study was to investigate annual changes of mortality/morbidity and DAMA of trauma patients in one Chinese Intensive Care Unit (ICU) in 9 years.

Methods

A retrospective analysis of data [age, Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation II (APACHE II), Glasgow Coma Scale (GCS), mortality rate, and DAMA] was performed with trauma patients admitted in the emergency ICU of the Second Affiliated Hospital of Zhejiang University from 2003 to 2011.

Results

The rate of total mortality (in-hospital death and dying at discharge) was 6.9 % and the rate of DAMA (deterioration at discharge and improvement at discharge) was 6.6 %. The mortality rate was significantly decreased from 11.1 to 4.6 %, and the rate of deterioration at discharge was increased from 2.8 to 6.4 %. Among the three periods (2003–2005, 2006–2008, and 2009–2011), the age and APACHE II score of patients in total death, deterioration at discharge, and death plus deterioration at discharge groups were highest in the period 2009–2011, whereas the GCS was statistically lower in all groups except in the deterioration at discharge group.

Conclusion

The medical quality of trauma care has been improved through gradual improvement of instruments and trained medical staffs. The rate of deterioration at discharge was increased, especially in elder patient group. The DAMA had a significant impact on the accurate assessment of trauma care, which should be paid more attention on its potential roles in the future.

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Abbreviations

ISS:

Injury Severity Score

APACHE II:

Acute Physiology and Chronic Health Evaluation II

GCS:

Glasgow Coma Scale

DAMA:

Discharge against medical advice

ICU:

Intensive Care Unit

EICU:

Standard ICU belonged to Department of Emergency Medicine

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Acknowledgments

This work was supported in part by the Specialized Research Fund of Doctoral Program of Higher Education (Grant No. 20120101120035), Zhejiang Medicines Health Science and Technology Project (No. 2013KYA098, No. 2012KYB092), the Program for Zhejiang Leading Team of S&T Innovation (Grant No. 2011R50018-18).

Conflict of interest

Li Ba, Mao Zhang, Lingmin Su, Zhongwei Cheng, and Yongan Xu declare that they have no conflict of interests.

Ethical standard

Each of authors declared that all procedures in this research were complied with Ethical Requirements of SAHZU.

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Author notes

    Authors and Affiliations

    1. Department of Emergency Medicine, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, People’s Republic of China

      L. Ba, M. Zhang, L. Su & Y. Xu

    2. Emergency Department, Ningxia Medical University, Yinchuan, 750000, People’s Republic of China

      Z. Cheng

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    1. L. Ba
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    2. M. Zhang
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    3. L. Su
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    5. Y. Xu
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    Correspondence to Y. Xu.

    Additional information

    L. Ba and M. Zhang contribute equally to this work (Co-first authors).

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    Ba, L., Zhang, M., Su, L. et al. Nine-year change of mortality and discharge against medical advice among major trauma patients in a Chinese Intensive Care Unit. Eur J Trauma Emerg Surg 42, 47–53 (2016). https://doi.org/10.1007/s00068-015-0511-2

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    • DOI: https://doi.org/10.1007/s00068-015-0511-2

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