Hazard Regression Models of Early Mortality in Trauma Centers

Details

• Alternative Title:
  J Am Coll Surg
• Personal Author:
  Clark, David E ; Qian, Jing ; Winchell, Robert J ; Betensky, Rebecca A
• Description:
  Background
  
  Factors affecting early hospital deaths after trauma may be different from factors affecting later hospital deaths, and the distribution of short and long prehospital times may vary among hospitals. Hazard regression (HR) models may therefore be more useful than logistic regression (LR) models for analysis of trauma mortality, especially when treatment effects at different time points are of interest.
  
  Study Design
  
  We obtained data for trauma center patients from the 2008–9 National Trauma Data Bank (NTDB). Cases were included if they had complete data for prehospital times, hospital times, survival outcome, age, vital signs, and severity scores. Cases were excluded if pulseless on admission, transferred in or out, or ISS<9. Using covariates proposed for the Trauma Quality Improvement Program and an indicator for each hospital, we compared LR models predicting survival at 8 hours after injury to HR models with survival censored at 8 hours. HR models were then modified to allow time-varying hospital effects.
  
  Results
  
  85,327 patients in 161 hospitals met inclusion criteria. Crude hazards peaked initially, then steadily declined. When hazard ratios were assumed constant in HR models, they were similar to odds ratios in LR models associating increased mortality with increased age, firearm mechanism, increased severity, more deranged physiology, and estimated hospital-specific effects. However, when hospital effects were allowed to vary by time, HR models demonstrated that hospital outliers were not the same at different times after injury.
  
  Conclusions
  
  HR models with time-varying hazard ratios reveal inconsistencies in treatment effects, data quality, and/or timing of early death among trauma centers. HR models are generally more flexible than LR models, can be adapted for censored data, and potentially offer a better tool for analysis of factors affecting early death after injury.
  
  
• Subjects:
  Aged Article Female Hospital Mortality Humans Injury Severity Score Logistic Models Male Odds Ratio Retrospective Studies Time Factors Trauma Centers Wounds And Injuries

  More +
• Source:
  J Am Coll Surg. 2012; 215(6):841-849.
• Pubmed ID:
  23036828
• Pubmed Central ID:
  PMC3790585
• Document Type:
  Journal Article
• Funding:
  R01 CA075971/CA/NCI NIH HHS/United States ; R01CE001594/CE/NCIPC CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  215
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:2329613132380561db5496ee47e73ac5e5cbe26374ac08d7c71dbf608624b80a
• Download URL:
  https://stacks.cdc.gov/view/cdc/33634/cdc_33634_DS1.pdf
• File Type:
  [PDF - 395.87 KB ]