Complication Rates among Trauma Centers

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

doi:10.1016/j.jamcollsurg.2009.08.003

« Previous Next »Journal of the American College of Surgeons
Volume 209, Issue 5 , Pages 595-602, November 2009

Complication Rates among Trauma Centers

Darwin N. Ang, MD, PhD, MPH
- Department of Surgery, University of Washington, Seattle, WA
- Harborview Injury Prevention and Research Center, Department of Surgery, University of Washington, Seattle, WA
- Department of Acute Care Surgery and Critical Care, University of Florida, Gainesville, FL
- Correspondence address: Darwin N Ang, MD, PhD, MPH, Division of Acute Care Surgery and Critical Care, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100286, Gainesville, FL 32610
Frederick P. Rivara, MD, MPH
- Harborview Injury Prevention and Research Center, Department of Surgery, University of Washington, Seattle, WA
- Department of Pediatrics, Department of Surgery, University of Washington, Seattle, WA
- Department of Epidemiology, Department of Surgery, University of Washington, Seattle, WA
Avery Nathens, MD, PhD, MPH, FACS
- St Michael's Hospital, Toronto, Ontario, Canada
Gregory J. Jurkovich, MD, FACS
- Department of Surgery, University of Washington, Seattle, WA
- Harborview Injury Prevention and Research Center, Department of Surgery, University of Washington, Seattle, WA
Ronald V. Maier, MD, FACS
- Department of Surgery, University of Washington, Seattle, WA
- Harborview Injury Prevention and Research Center, Department of Surgery, University of Washington, Seattle, WA
Jin Wang, PhD
- Harborview Injury Prevention and Research Center, Department of Surgery, University of Washington, Seattle, WA
Ellen J. MacKenzie, PhD
- Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Received 20 June 2009; received in revised form 4 August 2009; accepted 7 August 2009. published online 22 September 2009.

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.

Abbreviations and Acronyms: AIS, Abbreviated Injury Scale, DVT, deep venous thrombosis, ED, emergency department, NTC, nontrauma center, RR, relative risk, TC, trauma center