A. J. Kerwin1, J. B. Burns1, J. H. Ra1, D. Ebler1, D. J. Skarupa1, N. Krumrei1, J. J. Tepas1 1University Of Florida,Acute Care Surgery,Jacksonville, FL, USA
Introduction: Today there is greater scrutiny of healthcare outcomes. Mortality is one quality indicator that has been used for benchmarking but there is more to mortality than meets the eye. Terminal care, percentage of penetrating trauma, patients presenting without vital signs (DOAs) and hospice discharges to can all impact a program’s mortality. Our objective was to examine the effect of this on trauma mortality.
Methods: Deidentified data from our quality management program for the years 2009- 2013 was reviewed to examine mortality as a quality indicator. We examined all deaths, death by injury type, hospice discharges, and DOAs. Chi-square analysis was performed for statistical analysis.
Results: For the period 2009- 2013 there were a total of 10,762 trauma service admits. There were 9,223 blunt trauma admits and 1,539 for penetrating trauma. There were 670 deaths during that time for an overall mortality rate of 6.2%. 480 (71.6%) deaths occurred following blunt trauma and 190 (28.4%) following penetrating trauma. Overall mortality following penetrating trauma was statistically significantly higher than after blunt trauma (11.9% vs. 5.2%; p<0.0001). During the study period there were 255 DOAs. Adding these to the overall mortality analysis increased the number of deaths by 38% and significantly increased the overall mortality rate to 8.5% (p= 0.001). During the study period there were 81 hospice discharges. Counting these patients in the mortality group gives a total of 751 deaths and significantly increases the mortality rate to 7.1% (p=0.0280).
Conclusion: Mortality is an important quality indicator for trauma programs but simply reporting crude mortality is misleading. Penetrating trauma, hospice discharges and DOAs can be important drivers of higher mortality that can reflect negatively upon a program. Hospice discharges should be included when reporting mortality. Trauma surgeons should work together to define uniform reporting of mortality as a quality indicator.