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Failure to rescue the elderly: a superior quality metric for trauma centers

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

Abstract

Background

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.

Methods

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.

Results

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.

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Author contributions

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.

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Authors and Affiliations

  1. Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite 8215N, Los Angeles, CA, 90048, USA

    G. Barmparas, E. J. Ley, A. Ko, M. Harada, K. R. Catchpole & B. L. Gewertz

  2. Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA

    M. J. Martin

  3. Madison College of Engineering, University of Wisconsin, Madison, WI, USA

    D. Weigmann

Authors
  1. G. Barmparas
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  2. E. J. Ley
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  4. A. Ko
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  5. M. Harada
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  6. D. Weigmann
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  7. K. R. Catchpole
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  8. B. L. Gewertz
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Correspondence to E. J. Ley.

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The authors have no conflicts of interest to report and have received no financial support in relation to this manuscript.

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Barmparas, G., Ley, E.J., Martin, M.J. et al. Failure to rescue the elderly: a superior quality metric for trauma centers. Eur J Trauma Emerg Surg 44, 377–384 (2018). https://doi.org/10.1007/s00068-017-0782-x

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  • DOI: https://doi.org/10.1007/s00068-017-0782-x

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