A METRIC OF OUR OWN: FAILURE TO RESCUE AFTER TRAUMA

Details

• Alternative Title:
  J Trauma Acute Care Surg
• Personal Author:
  Holena, Daniel N ; Kaufman, Elinore J ; Delgado, M Kit ; Wiebe, Douglas J ; Carr, Brendan G ; Christie, Jason D ; Reilly, Patrick M
• Description:
  Background
  
  Failure to rescue (FTR) is defined as death after an adverse event. The original metric was derived in elective surgical populations and reclassifies deaths not preceded by recorded adverse events as FTR cases under the assumption these deaths resulted from missed adverse events. This approach lacks face validity in trauma because patients often die without adverse events as a direct result of injury. Another common approach simply excludes deaths without recorded adverse events, but this approach reduces the reliability of the FTR metric. We hypothesized that a hybrid metric excluding expected deaths but otherwise including patients without recorded adverse events in FTR analysis would improve face validity and reliability relative to existing methods.
  
  Methods
  
  Using 3 years of single-state adult trauma registry data from 30 trauma centers, we constructed 3 FTR metrics: 1.) Excluding deaths not preceded by adverse events (FTR-E), 2.) Reclassifying deaths not preceded by adverse events (FTR-R), and 2.) Including deaths not preceded by adverse events in FTR analysis except those with predicted mortality >50% (FTR-T). Mortality, adverse event, and FTR rates were calculated under each method, and reliability was tested using Spearman’s correlation for split-sample center rankings.
  
  Results
  
  A total of 89,780 patients were included (median age 57 (IQR 26–73), 85% Caucasian, 59% male, 92% blunt, median ISS 9 (IQR5–14)). FTR rates varied by metric (FTR-E: 11.2%; FTR-R 31.2%; FTR-T 21.4%)), as did the proportion of deaths preceded by adverse events (FTR-E 28%; FTR-R: 100%; FTR-T: 60%). Spit-sample reliability was higher FTR-T than FTR-E (rho=0.59 vs) (rho=0.27, p<0.001).
  
  Conclusions
  
  A trauma-specific FTR metric increases face validity and reliability relative to other FTR methods which may be employed in trauma populations. Future trauma outcomes studies examining FTR rates should use a metric designed for this cohort.
  
  Level of Evidence
  
  Level III
  
  
• Subjects:
  Adult Aged Female Hospital Mortality Humans Male Middle Aged Registries Retrospective Studies Trauma Centers Trauma Severity Indices Treatment Failure Wounds And Injuries

  More +
• Source:
  J Trauma Acute Care Surg. 83(4):698-704.
• Pubmed ID:
  28538625
• Pubmed Central ID:
  PMC5608646
• Document Type:
  Journal Article
• Funding:
  K08 HL131995/HL/NHLBI NIH HHS/United States ; K12 HL109009/HL/NHLBI NIH HHS/United States ; R49 CE002474/CE/NCIPC CDC HHS/United States
• Place as Subject:
  Pennsylvania
• Volume:
  83
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f1e7a4192c11b4ec5ca18c3c057e65b4febaade4e7df3254d0ec764d4fbbe4b6
• Download URL:
  https://stacks.cdc.gov/view/cdc/55065/cdc_55065_DS1.pdf
• File Type:
  [PDF - 1.67 MB ]