Failure to rescue the elderly: a superior quality metric for trauma centers
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Trauma centers require reliable metrics to better compare the quality of care delivered. We compared mortality after a reported complication, termed failure to rescue (FTR), and FTR in the elderly (age >65 years) (FTRE) to determine which is a superior metric to assess quality of care delivered by trauma centers.
This was a retrospective review of the National Trauma Databank (NTDB) research data sets 2010 and 2011. Patients ≥16 years admitted to centers reporting ≥80% of AIS and/or ≥ 20% of comorbidities with > 200 subjects in the NTDB were selected. Centers were classified based on the rate of FTR and FTRE (<5 vs. 5–14 vs. ≥15%). The primary outcome was adjusted mortality for each group of trauma centers based on FTR and FTRE classifications.
The overall mean ± SD FTR rate was 7.2 ± 5.2% and FTRE was 10.4 ± 7.9%. The adjusted odds ratio (AOR) for mortality was not different when centers with FTR <5% were compared to those with FTR of 5–14 or ≥15%. In contrast, a stepwise increase in FTRE predicted a significantly higher mortality when centers with FTRE 5% were compared to those with 5–14% (AOR: 1.05, p = 0.031) and ≥15% (AOR: 1.13, p < 0.001). Similarly, stepwise increase in FTRE predicted higher adjusted mortality for severely and critically injured patients, whereas FTR did not.
Conclusions and relevance
Higher FTRE predicts increased adjusted mortality better than FTR after trauma and should, therefore, be considered an important metric when comparing quality care delivered by trauma centers.
KeywordsFailure to rescue Elderly Trauma Quality care Outcomes Complications
Study conception and design: GB, MD; MM, MD; BLG, MD; and EJL, MD. Acquisition of data: GB, MD; AK, MD; MH, BS; and EJL, MD. Analysis and interpretation of data: GB, MD; MM, MD; and EJL, MD. Literature review: GB, MD; MM, MD; and EJL, MD. Drafting of manuscript: GB, MD; MM, MD; BLG, MD; and EJL, MD. Critical revision: DAW, PhD; KRC, PhD; BLG, MD; and EJL, MD.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to report and have received no financial support in relation to this manuscript.
- 1.American College of Surgeons. Resources for optimal care of the injured patient. Am Coll Surg. 2006;98.Google Scholar
- 2.Champion HR, Copes WS, Sacco WJ, et al. The major trauma outcome study: establishing national norms for trauma care. J Trauma. 1990;30(11):1356–65. http://www.ncbi.nlm.nih.gov/pubmed/2231804. Accessed 2 June 2014.
- 9.U.S. Census Bureau DIS. 2012 National Population Projections. http://www.census.gov/population/projections/data/national/2012.html. Accessed 20 Mar 2014.
- 11.WISQARS (Web-based Injury Statistics Query and Reporting System)|Injury Center|CDC. http://www.cdc.gov/injury/wisqars/. Accessed 15 June 2014.
- 16.Hashmi ZG, Dimick JB, Efron DT, et al. Reliability adjustment: a necessity for trauma center ranking and benchmarking. J Trauma Acute Care Surg. 2013;75(1):166–72. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3989535&tool=pmcentrez&rendertype=abstract. Accessed 21 Dec 2014.
- 18.Silber JH, Rosenbaum PR. A spurious correlation between hospital mortality and complication rates: the importance of severity adjustment. Med Care. 1997;35(10 Suppl):OS77–OS92. http://www.ncbi.nlm.nih.gov/pubmed/9339779. Accessed 21 Mar 2014.
- 20.Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg. 2009;250(6):1029–34. http://www.ncbi.nlm.nih.gov/pubmed/19953723. Accessed 21 Mar 2014.
- 26.McKevitt EC, Calvert E, Ng A, et al. Geriatric trauma: resource use and patient outcomes. Can J Surg. 2003;46(3):211–5. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3211738&tool=pmcentrez&rendertype=abstract. Accessed 21 Dec 2014.
- 28.Asplund K, Gustafson Y, Jacobsson C, et al. Geriatric-based versus general wards for older acute medical patients: a randomized comparison of outcomes and use of resources. J Am Geriatr Soc. 2000;48(11):1381–8. http://www.ncbi.nlm.nih.gov/pubmed/11083312. Accessed 22 Dec 2014.
- 32.Matsushima K, Schaefer EW, Won EJ, Armen SB, Indeck MC, Soybel DI. Positive and negative volume-outcome relationships in the geriatric trauma population. JAMA Surg. 2014;149(4):319–26.Google Scholar