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In Search of Benchmarking for Mortality Following Multiple Trauma: A Swiss Trauma Center Experience

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Abstract

Background

The manifestations associated with non-survival after multiple trauma may vary importantly between countries and institutions. The aim of the present study was to assess the quality of performance by comparing actual mortality rates to the literature.

Methods

The study involved evaluation of a prospective consecutive multiple trauma cohort (injury severity score, ISS > 16) primarily admitted to a university hospital. Univariate and multivariate testing of routine parameters and scores, such as the Trauma and Injury Severity Score (TRISS), was used to determine their predictive powers for mortality.

Results

The 30-day mortality of 22.8% (n = 54) exactly matched predicted TRISS versions of Champion or the Major Trauma Outcome Study for our 237 multiple trauma patients (42.8 ± 20.9 years; ISS 29.5 ± 11.5). Univariate analysis revealed significant differences between survivors and non-survivors when compared for age, ISS, Glasgow coma scale (GCS), pulse oximeter saturation (SapO2), hemoglobin, prothrombin time, and lactate. In multivariate analysis, age, ISS, and GCS (P < 0.001 each) functioned as major independent prognostic parameters of both 24 h and 30-day mortality. Various TRISS versions hardly differed in their precision (area under the curve [AUC] 0.83–0.84), but they did differ considerably in their level of requirement, with the TRISS using newer National Trauma Data Bank coefficients (NTDB-TRISS) offering the highest target benchmark (predicted mortality 13%, Z value –5.7) in the prediction of 30-day mortality.

Conclusions

Because of the current lack of a single, internationally accepted scoring system for the prediction of mortality after multiple trauma, the comparison of outcomes between medical centers remains unreliable. To achieve effective quality control, a practical benchmarking model, such as the TRISS-NTDB, should be used worldwide.

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Acknowledgments

This study was financially supported by the Swiss National Science Foundation (NCCR-CO-ME), the Scientific Foundation of the Swiss Accident Insurance Fund (SUVA), the Voluntary Academic Society (FAG) Basel, the Swiss group of Computer Assisted Radiology and Surgery (CARCAS) Basel, the Unit of Interventional Radiology at the University Hospital Basel, and the Swiss National Information Center for Accident Prevention (BFU). The authors thank J. Buchanan for editorial assistance with the manuscript, J. Reinkensmeier for help creating the computer database, and all the patients and collaborators involved in the study at the University Hospital Basel.

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Authors and Affiliations

  1. Computer Assisted Radiology & Surgery Switzerland (CARCAS), University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Ida Füglistaler-Montali, Corinna Attenberger, Philipp Füglistaler, Augustinus L. Jacob, Felix Amsler & Thomas Gross

  2. General and Visceral Surgery, University Hospital Münster, Waldeyerstr. 1, 48149, Munster, Germany

    Ida Füglistaler-Montali

  3. General and Visceral Surgery, Klinikum Augsburg, Steglinstr. 2, 86156, Augsburg, Germany

    Corinna Attenberger

  4. Vascular Surgery, St. Franziskus Hospital, Hohenzollernring 72, 48145, Munster, Germany

    Philipp Füglistaler

  5. Department of Interventional Radiology, University Hospital Basel, Petersgraben, 4031, Basel, Switzerland

    Augustinus L. Jacob

  6. Realpstr. 57, 4057, Basel, Switzerland

    Thomas Gross

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  1. Ida Füglistaler-Montali
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  2. Corinna Attenberger
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  6. Thomas Gross
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Correspondence to Thomas Gross.

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Füglistaler-Montali, I., Attenberger, C., Füglistaler, P. et al. In Search of Benchmarking for Mortality Following Multiple Trauma: A Swiss Trauma Center Experience. World J Surg 33, 2477–2489 (2009). https://doi.org/10.1007/s00268-009-0193-1

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