Z. G. Hashmi1, C. K. Zogg1, M. P. Jarman1, J. C. McCarty1, T. Uribe-Leitz1, E. Goralnick1, A. Salim1, A. H. Haider1 1Brigham And Women’s Hospital,Surgery,Boston, MA, USA
Introduction: Recent estimates suggest that nationwide trauma quality improvement has the potential to save more than 200,000 lives in just over a decade. Citing this enormous burden, the National Academies of Sciences, Engineering and Medicine (NASEM) has mandated several measures aimed at achieving “Zero Preventable Deaths after Injury.” However, the geographic distribution of these potentially preventable trauma deaths, which will be critical in planning and implementing regional quality improvement efforts, remains unknown. The objective of this study is to determine the state-level estimates of potentially preventable trauma deaths in the United States.
Methods: We included all adult (age≥16) trauma patients with blunt and/or penetrating injuries reported to the State Inpatient Database 2014 for Arizona, Florida, Kentucky and New York. Hierarchical logistic regression, adjusting for age, sex, race, mechanism of injury, intent of injury, anatomic injury severity (Trauma Mortality Prediction Model), presence of severe head injury and hospital volume, was used to benchmark hospitals into quintiles of reliability-adjusted mortality rate. Generalized linear modeling was then used to estimate the relative-risk of death for patients treated at hospitals among the best-performing quintile across the four states versus the remainder of hospitals in each state. This relative-risk of death was used to estimate the number of potentially preventable trauma deaths in each state if all patients were treated at the best-performing hospitals.
Results: A total of 176,240 trauma patients treated at 331 hospitals across the four states were analyzed. The overall adjusted mortality rate was 2.3%. A total of 67 hospitals were benchmarked into the best-performing quintile across the four states with an adjusted mortality rate of 1.6%. The remainder of the hospitals in each state had a significantly higher relative risk of mortality than the best-performing hospitals (Table). A total of 2,052 [95% confidence interval (1,843-2,228)] trauma deaths were deemed potentially preventable across the four states with the most preventable deaths occurring in New York [923 (851-987)] and the highest proportion occurring in Kentucky (18.2 per 1000 trauma admissions).
Conclusion: Large geographic variation exists in the number and proportion of potentially preventable trauma deaths. This study establishes state-specific targets for regional trauma quality improvement initiatives aiming to achieve “Zero Preventable Deaths After Injury.”
