Then We All Fall Down: Fall Mortality by Trauma Center Level
Abstract Background Ground-level falls (GLF) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity and physiologic derangement. Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjus...
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| Veröffentlicht in: | The Journal of surgical research 2017-09, Vol.217, p.36-44.e2 |
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| creator | Roubik, CPT Daniel, MD Cook, Alan D., MD, FACS Ward, Jeanette G., MS-CR Chapple, Kristina M., Ph.D Teperman, Sheldon, MD, FACS Stone, Melvin E., MD, FACS Gross, Brian, BS Moore, Forrest O., MD, FACS |
| description | Abstract Background Ground-level falls (GLF) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity and physiologic derangement. Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would evaluate the degree to which need for care was met by provision of care. Materials and Methods This retrospective cohort study utilized National Trauma Data Bank files for 2007-2014. Trauma center level was defined as American College of Surgeons (ACS) level I/II, ACS III/IV, State I/II and State III/IV for within-group homogeneity. Risk-adjusted expected mortality was estimated using hierarchical, multivariable regression techniques. Results Analysis of 812,053 patients’ data revealed the proportion of GLF in the NTDB increased 8.7% (14.1% to 22.8%) over the eight years studied. Mortality was 4.21% overall with a three-fold increase for those 60 and older versus younger than 60 (4.93% vs. 1.46%, p |
| doi_str_mv | 10.1016/j.jss.2016.12.039 |
| format | Article |
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Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would evaluate the degree to which need for care was met by provision of care. Materials and Methods This retrospective cohort study utilized National Trauma Data Bank files for 2007-2014. Trauma center level was defined as American College of Surgeons (ACS) level I/II, ACS III/IV, State I/II and State III/IV for within-group homogeneity. Risk-adjusted expected mortality was estimated using hierarchical, multivariable regression techniques. Results Analysis of 812,053 patients’ data revealed the proportion of GLF in the NTDB increased 8.7% (14.1% to 22.8%) over the eight years studied. Mortality was 4.21% overall with a three-fold increase for those 60 and older versus younger than 60 (4.93% vs. 1.46%, p<0.001). O:E was lowest for ACS III/IV, (0.973, 95% CI 0.971-0.975) and highest for State III/IV (1.043, 95% CI 1.041-1.044). Conclusion Risk-adjusted outcomes can be measured and meaningfully compared among groups of trauma centers. Differential O:E for ACS III/IV and State III/IV centers suggests factors beyond case mix alone influence outcomes for GLF patients. More work is needed to optimize trauma care for GLF patients across the spectrum of trauma center capability.</description><identifier>ISSN: 0022-4804</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2016.12.039</identifier><identifier>PMID: 28117092</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Accidental Falls - mortality ; Aged ; Aged, 80 and over ; Comparative assessment ; Female ; Ground-level fall ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Outcomes ; Retrospective Studies ; Risk adjustment ; Risk Factors ; Surgery ; Trauma center level ; Trauma Centers - statistics & numerical data ; United States - epidemiology</subject><ispartof>The Journal of surgical research, 2017-09, Vol.217, p.36-44.e2</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-7aa471164af7f913b3196ea0983c50cbd2d40b5b85b7d3962cda9333505bf8b73</citedby><cites>FETCH-LOGICAL-c408t-7aa471164af7f913b3196ea0983c50cbd2d40b5b85b7d3962cda9333505bf8b73</cites><orcidid>0000-0003-0301-3125 ; 0000-0001-6239-0655</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022480417300021$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28117092$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roubik, CPT Daniel, MD</creatorcontrib><creatorcontrib>Cook, Alan D., MD, FACS</creatorcontrib><creatorcontrib>Ward, Jeanette G., MS-CR</creatorcontrib><creatorcontrib>Chapple, Kristina M., Ph.D</creatorcontrib><creatorcontrib>Teperman, Sheldon, MD, FACS</creatorcontrib><creatorcontrib>Stone, Melvin E., MD, FACS</creatorcontrib><creatorcontrib>Gross, Brian, BS</creatorcontrib><creatorcontrib>Moore, Forrest O., MD, FACS</creatorcontrib><title>Then We All Fall Down: Fall Mortality by Trauma Center Level</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description>Abstract Background Ground-level falls (GLF) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity and physiologic derangement. Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would evaluate the degree to which need for care was met by provision of care. Materials and Methods This retrospective cohort study utilized National Trauma Data Bank files for 2007-2014. Trauma center level was defined as American College of Surgeons (ACS) level I/II, ACS III/IV, State I/II and State III/IV for within-group homogeneity. Risk-adjusted expected mortality was estimated using hierarchical, multivariable regression techniques. Results Analysis of 812,053 patients’ data revealed the proportion of GLF in the NTDB increased 8.7% (14.1% to 22.8%) over the eight years studied. Mortality was 4.21% overall with a three-fold increase for those 60 and older versus younger than 60 (4.93% vs. 1.46%, p<0.001). O:E was lowest for ACS III/IV, (0.973, 95% CI 0.971-0.975) and highest for State III/IV (1.043, 95% CI 1.041-1.044). Conclusion Risk-adjusted outcomes can be measured and meaningfully compared among groups of trauma centers. Differential O:E for ACS III/IV and State III/IV centers suggests factors beyond case mix alone influence outcomes for GLF patients. More work is needed to optimize trauma care for GLF patients across the spectrum of trauma center capability.</description><subject>Accidental Falls - mortality</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Comparative assessment</subject><subject>Female</subject><subject>Ground-level fall</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Outcomes</subject><subject>Retrospective Studies</subject><subject>Risk adjustment</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Trauma center level</subject><subject>Trauma Centers - statistics & numerical data</subject><subject>United States - epidemiology</subject><issn>0022-4804</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFv1DAQhS0EokvhB3BBOXJJ8NhJbANCqrYUKi3iwCKOlu1MhIM3KXbSav89jrZw4NDLzFh670n-HiEvgVZAoX0zVENKFctnBayiXD0iG6CqKWUr-GOyoZSxspa0PiPPUhpofivBn5IzJgEEVWxD3u9_4lj8wOIihOLK5HE53Y1vT-eXKc4m-PlY2GOxj2Y5mGKL44yx2OEthufkSW9Cwhf3-5x8v_q4334ud18_XW8vdqWrqZxLYUwtANra9KJXwC0H1aKhSnLXUGc71tXUNlY2VnRctcx1RnHOG9rYXlrBz8nrU-5NnH4vmGZ98MlhCGbEaUkaZAstbSWwLIWT1MUppYi9von-YOJRA9UrND3oDE2v0DQwnaFlz6v7-MUesPvn-EspC96dBJg_eesx6uQ8jg47H9HNupv8g_Ef_nO74EfvTPiFR0zDtMQx09OgUzbob2tra2kg-NoY8D9xYY7G</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Roubik, CPT Daniel, MD</creator><creator>Cook, Alan D., MD, FACS</creator><creator>Ward, Jeanette G., MS-CR</creator><creator>Chapple, Kristina M., Ph.D</creator><creator>Teperman, Sheldon, MD, FACS</creator><creator>Stone, Melvin E., MD, FACS</creator><creator>Gross, Brian, BS</creator><creator>Moore, Forrest O., MD, FACS</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0301-3125</orcidid><orcidid>https://orcid.org/0000-0001-6239-0655</orcidid></search><sort><creationdate>20170901</creationdate><title>Then We All Fall Down: Fall Mortality by Trauma Center Level</title><author>Roubik, CPT Daniel, MD ; Cook, Alan D., MD, FACS ; Ward, Jeanette G., MS-CR ; Chapple, Kristina M., Ph.D ; Teperman, Sheldon, MD, FACS ; Stone, Melvin E., MD, FACS ; Gross, Brian, BS ; Moore, Forrest O., MD, FACS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-7aa471164af7f913b3196ea0983c50cbd2d40b5b85b7d3962cda9333505bf8b73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Accidental Falls - mortality</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Comparative assessment</topic><topic>Female</topic><topic>Ground-level fall</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Outcomes</topic><topic>Retrospective Studies</topic><topic>Risk adjustment</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Trauma center level</topic><topic>Trauma Centers - statistics & numerical data</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roubik, CPT Daniel, MD</creatorcontrib><creatorcontrib>Cook, Alan D., MD, FACS</creatorcontrib><creatorcontrib>Ward, Jeanette G., MS-CR</creatorcontrib><creatorcontrib>Chapple, Kristina M., Ph.D</creatorcontrib><creatorcontrib>Teperman, Sheldon, MD, FACS</creatorcontrib><creatorcontrib>Stone, Melvin E., MD, FACS</creatorcontrib><creatorcontrib>Gross, Brian, BS</creatorcontrib><creatorcontrib>Moore, Forrest O., MD, FACS</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roubik, CPT Daniel, MD</au><au>Cook, Alan D., MD, FACS</au><au>Ward, Jeanette G., MS-CR</au><au>Chapple, Kristina M., Ph.D</au><au>Teperman, Sheldon, MD, FACS</au><au>Stone, Melvin E., MD, FACS</au><au>Gross, Brian, BS</au><au>Moore, Forrest O., MD, FACS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Then We All Fall Down: Fall Mortality by Trauma Center Level</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>217</volume><spage>36</spage><epage>44.e2</epage><pages>36-44.e2</pages><issn>0022-4804</issn><eissn>1095-8673</eissn><abstract>Abstract Background Ground-level falls (GLF) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity and physiologic derangement. Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would evaluate the degree to which need for care was met by provision of care. Materials and Methods This retrospective cohort study utilized National Trauma Data Bank files for 2007-2014. Trauma center level was defined as American College of Surgeons (ACS) level I/II, ACS III/IV, State I/II and State III/IV for within-group homogeneity. Risk-adjusted expected mortality was estimated using hierarchical, multivariable regression techniques. Results Analysis of 812,053 patients’ data revealed the proportion of GLF in the NTDB increased 8.7% (14.1% to 22.8%) over the eight years studied. Mortality was 4.21% overall with a three-fold increase for those 60 and older versus younger than 60 (4.93% vs. 1.46%, p<0.001). O:E was lowest for ACS III/IV, (0.973, 95% CI 0.971-0.975) and highest for State III/IV (1.043, 95% CI 1.041-1.044). Conclusion Risk-adjusted outcomes can be measured and meaningfully compared among groups of trauma centers. Differential O:E for ACS III/IV and State III/IV centers suggests factors beyond case mix alone influence outcomes for GLF patients. More work is needed to optimize trauma care for GLF patients across the spectrum of trauma center capability.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28117092</pmid><doi>10.1016/j.jss.2016.12.039</doi><orcidid>https://orcid.org/0000-0003-0301-3125</orcidid><orcidid>https://orcid.org/0000-0001-6239-0655</orcidid></addata></record> |
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| subjects | Accidental Falls - mortality Aged Aged, 80 and over Comparative assessment Female Ground-level fall Hospital Mortality Humans Logistic Models Male Outcomes Retrospective Studies Risk adjustment Risk Factors Surgery Trauma center level Trauma Centers - statistics & numerical data United States - epidemiology |
| title | Then We All Fall Down: Fall Mortality by Trauma Center Level |
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