TY - JOUR
T1 - Moving beyond personnel and process
T2 - A case for incorporating outcome measures in the trauma center designation process
AU - Shafi, Shahid
AU - Friese, Randall
AU - Gentilello, Larry M.
PY - 2008/2
Y1 - 2008/2
N2 - Hypothesis: Similarly designated trauma centers do not achieve similar outcomes. Design: Outcomes study. Setting: Academic research. Participants: Forty-seven American College of Surgeons-verified level I trauma centers that contributed more than 1000 patients to the National Trauma Data Bank (from January 1999 to December 2003) were identified. Main Outcome Measures: Patients were classified into the following 3 injury severity groups using a combination of anatomical and physiological measures: mild (Injury Severity Score [ISS] of <25 with systolic blood pressure [SBP] of ≥90 mm Hg [n = 184 650]), moderate (ISS of ≥25 with SBP of ≥90 mm Hg or ISS of <25 with SBP of <90 mm Hg [n = 22 586]), and severe (ISS of ≥25 with SBP of <90 mm Hg [n = 4243]). The mean survival for each group was calculated. Individual centers were considered outliers if their patient survival was statistically significantly different from the mean survival for each severity group. Results: The mean survival of patients with mild, moderate, and severe injuries was 99%, 75%, and 35%, respectively. For mild injuries, survival at 5 centers (11%) was significantly worse than that at their counterpart centers. With increasing injury severity, the percentages of outcome disparities increased (15% of centers for moderate injuries and 21% of centers for severe injuries) and persisted in subgroups of patients with head injuries, patients sustaining penetrating injuries, and older (>55 years) individuals. Conclusions: When treating patients with similar injury severity, similarly designated level I trauma centers may not achieve similar outcomes, suggesting the existence of a quality chasm in trauma care. Trauma center verification may require the use of outcome measures when determining trauma center status.
AB - Hypothesis: Similarly designated trauma centers do not achieve similar outcomes. Design: Outcomes study. Setting: Academic research. Participants: Forty-seven American College of Surgeons-verified level I trauma centers that contributed more than 1000 patients to the National Trauma Data Bank (from January 1999 to December 2003) were identified. Main Outcome Measures: Patients were classified into the following 3 injury severity groups using a combination of anatomical and physiological measures: mild (Injury Severity Score [ISS] of <25 with systolic blood pressure [SBP] of ≥90 mm Hg [n = 184 650]), moderate (ISS of ≥25 with SBP of ≥90 mm Hg or ISS of <25 with SBP of <90 mm Hg [n = 22 586]), and severe (ISS of ≥25 with SBP of <90 mm Hg [n = 4243]). The mean survival for each group was calculated. Individual centers were considered outliers if their patient survival was statistically significantly different from the mean survival for each severity group. Results: The mean survival of patients with mild, moderate, and severe injuries was 99%, 75%, and 35%, respectively. For mild injuries, survival at 5 centers (11%) was significantly worse than that at their counterpart centers. With increasing injury severity, the percentages of outcome disparities increased (15% of centers for moderate injuries and 21% of centers for severe injuries) and persisted in subgroups of patients with head injuries, patients sustaining penetrating injuries, and older (>55 years) individuals. Conclusions: When treating patients with similar injury severity, similarly designated level I trauma centers may not achieve similar outcomes, suggesting the existence of a quality chasm in trauma care. Trauma center verification may require the use of outcome measures when determining trauma center status.
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U2 - 10.1001/archsurg.2007.29
DO - 10.1001/archsurg.2007.29
M3 - Article
C2 - 18283135
AN - SCOPUS:39549110206
SN - 0004-0010
VL - 143
SP - 115
EP - 119
JO - Archives of Surgery
JF - Archives of Surgery
IS - 2
ER -