Complication Rates among Trauma Centers

Darwin N. Ang, Frederick P. Rivara, Avery Nathens, Gregory Jurkovich, Ronald V. Maier, Jin Wang, Ellen J. MacKenzie

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: The goal of this study was to examine the association between patient complications and admission to Level I trauma centers (TC) compared with nontrauma centers (NTC). Study Design: This was a retrospective cohort study of data derived from the National Study on the Costs and Outcomes of Trauma (NSCOT). Patients were recruited from 18 Level I TCs and 51 NTCs in 15 regions encompassing 14 states. Trained study nurses, using standardized forms, abstracted the medical records of the patients. The overall number of complications per patient was identified, as was the presence or absence of 13 specific complications. Results: Patients treated in TCs were more likely to have any complication compared with patients in NTCs, with an adjusted relative risk (RR) of 1.34 (95% CI, 1.03, 1.74). For individual complications, only the urinary tract infection RR of 1.94 (95% CI, 1.07, 3.17) was significantly higher in TCs. TC patients were more likely to have 3 or more complications (RR, 1.83; 95% CI, 1.16, 2.90). Treatment variables that are surrogates for markers of injury severity, such as use of pulmonary artery catheters, multiple operations, massive transfusions (> 2,500 mL packed red blood cells), and invasive brain catheters, occurred significantly more often in TCs. Conclusions: Trauma centers have a slightly higher incidence rate of complications, even after adjusting for patient case mix. Aggressive treatment may account for a significant portion of TC-associated complications. Pulmonary artery catheter use and intubation had the most influence on overall TC complication rates. Additional study is needed to provide accurate benchmark measures of complication rates and to determine their causes.

Original languageEnglish (US)
Pages (from-to)595-602
Number of pages8
JournalJournal of the American College of Surgeons
Volume209
Issue number5
DOIs
StatePublished - Nov 1 2009
Externally publishedYes

Fingerprint

Trauma Centers
Catheters
Pulmonary Artery
Benchmarking
Diagnosis-Related Groups
Patient Admission
Wounds and Injuries
Intubation
Urinary Tract Infections
Medical Records
Cohort Studies
Retrospective Studies
Erythrocytes
Biomarkers
Nurses
Costs and Cost Analysis
Incidence
Brain
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Ang, D. N., Rivara, F. P., Nathens, A., Jurkovich, G., Maier, R. V., Wang, J., & MacKenzie, E. J. (2009). Complication Rates among Trauma Centers. Journal of the American College of Surgeons, 209(5), 595-602. https://doi.org/10.1016/j.jamcollsurg.2009.08.003

Complication Rates among Trauma Centers. / Ang, Darwin N.; Rivara, Frederick P.; Nathens, Avery; Jurkovich, Gregory; Maier, Ronald V.; Wang, Jin; MacKenzie, Ellen J.

In: Journal of the American College of Surgeons, Vol. 209, No. 5, 01.11.2009, p. 595-602.

Research output: Contribution to journalArticle

Ang, DN, Rivara, FP, Nathens, A, Jurkovich, G, Maier, RV, Wang, J & MacKenzie, EJ 2009, 'Complication Rates among Trauma Centers', Journal of the American College of Surgeons, vol. 209, no. 5, pp. 595-602. https://doi.org/10.1016/j.jamcollsurg.2009.08.003
Ang, Darwin N. ; Rivara, Frederick P. ; Nathens, Avery ; Jurkovich, Gregory ; Maier, Ronald V. ; Wang, Jin ; MacKenzie, Ellen J. / Complication Rates among Trauma Centers. In: Journal of the American College of Surgeons. 2009 ; Vol. 209, No. 5. pp. 595-602.
@article{b7b7d10ec1af4048b0a6e624dad43617,
title = "Complication Rates among Trauma Centers",
abstract = "Background: The goal of this study was to examine the association between patient complications and admission to Level I trauma centers (TC) compared with nontrauma centers (NTC). Study Design: This was a retrospective cohort study of data derived from the National Study on the Costs and Outcomes of Trauma (NSCOT). Patients were recruited from 18 Level I TCs and 51 NTCs in 15 regions encompassing 14 states. Trained study nurses, using standardized forms, abstracted the medical records of the patients. The overall number of complications per patient was identified, as was the presence or absence of 13 specific complications. Results: Patients treated in TCs were more likely to have any complication compared with patients in NTCs, with an adjusted relative risk (RR) of 1.34 (95{\%} CI, 1.03, 1.74). For individual complications, only the urinary tract infection RR of 1.94 (95{\%} CI, 1.07, 3.17) was significantly higher in TCs. TC patients were more likely to have 3 or more complications (RR, 1.83; 95{\%} CI, 1.16, 2.90). Treatment variables that are surrogates for markers of injury severity, such as use of pulmonary artery catheters, multiple operations, massive transfusions (> 2,500 mL packed red blood cells), and invasive brain catheters, occurred significantly more often in TCs. Conclusions: Trauma centers have a slightly higher incidence rate of complications, even after adjusting for patient case mix. Aggressive treatment may account for a significant portion of TC-associated complications. Pulmonary artery catheter use and intubation had the most influence on overall TC complication rates. Additional study is needed to provide accurate benchmark measures of complication rates and to determine their causes.",
author = "Ang, {Darwin N.} and Rivara, {Frederick P.} and Avery Nathens and Gregory Jurkovich and Maier, {Ronald V.} and Jin Wang and MacKenzie, {Ellen J.}",
year = "2009",
month = "11",
day = "1",
doi = "10.1016/j.jamcollsurg.2009.08.003",
language = "English (US)",
volume = "209",
pages = "595--602",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Complication Rates among Trauma Centers

AU - Ang, Darwin N.

AU - Rivara, Frederick P.

AU - Nathens, Avery

AU - Jurkovich, Gregory

AU - Maier, Ronald V.

AU - Wang, Jin

AU - MacKenzie, Ellen J.

PY - 2009/11/1

Y1 - 2009/11/1

N2 - Background: The goal of this study was to examine the association between patient complications and admission to Level I trauma centers (TC) compared with nontrauma centers (NTC). Study Design: This was a retrospective cohort study of data derived from the National Study on the Costs and Outcomes of Trauma (NSCOT). Patients were recruited from 18 Level I TCs and 51 NTCs in 15 regions encompassing 14 states. Trained study nurses, using standardized forms, abstracted the medical records of the patients. The overall number of complications per patient was identified, as was the presence or absence of 13 specific complications. Results: Patients treated in TCs were more likely to have any complication compared with patients in NTCs, with an adjusted relative risk (RR) of 1.34 (95% CI, 1.03, 1.74). For individual complications, only the urinary tract infection RR of 1.94 (95% CI, 1.07, 3.17) was significantly higher in TCs. TC patients were more likely to have 3 or more complications (RR, 1.83; 95% CI, 1.16, 2.90). Treatment variables that are surrogates for markers of injury severity, such as use of pulmonary artery catheters, multiple operations, massive transfusions (> 2,500 mL packed red blood cells), and invasive brain catheters, occurred significantly more often in TCs. Conclusions: Trauma centers have a slightly higher incidence rate of complications, even after adjusting for patient case mix. Aggressive treatment may account for a significant portion of TC-associated complications. Pulmonary artery catheter use and intubation had the most influence on overall TC complication rates. Additional study is needed to provide accurate benchmark measures of complication rates and to determine their causes.

AB - Background: The goal of this study was to examine the association between patient complications and admission to Level I trauma centers (TC) compared with nontrauma centers (NTC). Study Design: This was a retrospective cohort study of data derived from the National Study on the Costs and Outcomes of Trauma (NSCOT). Patients were recruited from 18 Level I TCs and 51 NTCs in 15 regions encompassing 14 states. Trained study nurses, using standardized forms, abstracted the medical records of the patients. The overall number of complications per patient was identified, as was the presence or absence of 13 specific complications. Results: Patients treated in TCs were more likely to have any complication compared with patients in NTCs, with an adjusted relative risk (RR) of 1.34 (95% CI, 1.03, 1.74). For individual complications, only the urinary tract infection RR of 1.94 (95% CI, 1.07, 3.17) was significantly higher in TCs. TC patients were more likely to have 3 or more complications (RR, 1.83; 95% CI, 1.16, 2.90). Treatment variables that are surrogates for markers of injury severity, such as use of pulmonary artery catheters, multiple operations, massive transfusions (> 2,500 mL packed red blood cells), and invasive brain catheters, occurred significantly more often in TCs. Conclusions: Trauma centers have a slightly higher incidence rate of complications, even after adjusting for patient case mix. Aggressive treatment may account for a significant portion of TC-associated complications. Pulmonary artery catheter use and intubation had the most influence on overall TC complication rates. Additional study is needed to provide accurate benchmark measures of complication rates and to determine their causes.

UR - http://www.scopus.com/inward/record.url?scp=70350134736&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70350134736&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2009.08.003

DO - 10.1016/j.jamcollsurg.2009.08.003

M3 - Article

VL - 209

SP - 595

EP - 602

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 5

ER -