The Location and Timing of Failure-to-Rescue Events Across a Statewide Trauma System.
Clinical outcomes
Failure to rescue
Quality of care
Trauma
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
10
05
2018
revised:
31
08
2018
accepted:
08
10
2018
entrez:
30
1
2019
pubmed:
30
1
2019
medline:
15
11
2019
Statut:
ppublish
Résumé
Failure to rescue (FTR) refers to death after a major complication. Defining the optimal context in which to reduce FTR after injury requires knowledge of where and when FTR events occur. Retrospective observational study of patients >16 y with a minimum Abbreviated Injury Score ≥2 at all 30 level I and II Pennsylvania trauma centers (2007-2015). Location and timing of the first major complication were collected. Complication, mortality, and FTR rates were calculated by location (prehospital, emergency department, operating room, stepdown unit, interventional radiology, intensive care unit (ICU), radiology, and the surgical ward) and by postadmission day. Kruskal-Wallis and chi-squared tests were used to compare variables. Major complications occurred in 15,388 of 178,602 (8.6%) patients. The median age was 58 y (interquartile range [IQR] 37-77 y), 78% were Caucasian, 68% were male, 89% were bluntly injured, and the median Injury Severity Score was 19 (IQR 10-29). Death occurred in 2512 of 15,388 patients with a major complication, for an FTR rate of 16.3%. Compared with non-FTR, FTR had earlier major complications (median day 2 [IQR 0-5 d] versus day 4 [IQR 2-8 d], P < 0.001). FTR rates were highest in the prehospital setting (42%), the operating room (33%), and the emergency department (32%), but the greatest number (1608 of 2512 total FTR events, 64%) occurred in the ICU. Pulmonary (32%) and cardiac (26%) complications most frequently contributed to FTR deaths. Interventions designed to reduce FTR after injury should focus on pulmonary and cardiac complications in the ICU.
Sections du résumé
BACKGROUND
Failure to rescue (FTR) refers to death after a major complication. Defining the optimal context in which to reduce FTR after injury requires knowledge of where and when FTR events occur.
MATERIALS AND METHODS
Retrospective observational study of patients >16 y with a minimum Abbreviated Injury Score ≥2 at all 30 level I and II Pennsylvania trauma centers (2007-2015). Location and timing of the first major complication were collected. Complication, mortality, and FTR rates were calculated by location (prehospital, emergency department, operating room, stepdown unit, interventional radiology, intensive care unit (ICU), radiology, and the surgical ward) and by postadmission day. Kruskal-Wallis and chi-squared tests were used to compare variables.
RESULTS
Major complications occurred in 15,388 of 178,602 (8.6%) patients. The median age was 58 y (interquartile range [IQR] 37-77 y), 78% were Caucasian, 68% were male, 89% were bluntly injured, and the median Injury Severity Score was 19 (IQR 10-29). Death occurred in 2512 of 15,388 patients with a major complication, for an FTR rate of 16.3%. Compared with non-FTR, FTR had earlier major complications (median day 2 [IQR 0-5 d] versus day 4 [IQR 2-8 d], P < 0.001). FTR rates were highest in the prehospital setting (42%), the operating room (33%), and the emergency department (32%), but the greatest number (1608 of 2512 total FTR events, 64%) occurred in the ICU. Pulmonary (32%) and cardiac (26%) complications most frequently contributed to FTR deaths.
CONCLUSIONS
Interventions designed to reduce FTR after injury should focus on pulmonary and cardiac complications in the ICU.
Identifiants
pubmed: 30691839
pii: S0022-4804(18)30743-1
doi: 10.1016/j.jss.2018.10.017
pmc: PMC6713902
mid: NIHMS1044544
pii:
doi:
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
529-535Subventions
Organisme : NHLBI NIH HHS
ID : K08 HL131995
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
Références
Am Surg. 2017 Mar 1;83(3):250-256
pubmed: 28316308
J Trauma. 2001 Jan;50(1):91-5
pubmed: 11231676
Crit Care Med. 2013 Feb;41(2):638-45
pubmed: 23263586
JAMA. 1985 Aug 23-30;254(8):1059-63
pubmed: 3894708
Chest. 2014 Feb;145(2):399-403
pubmed: 24493512
JAMA. 2002 Jan 16;287(3):345-55
pubmed: 11790214
J Trauma. 2011 Mar;70(3):575-82
pubmed: 21610345
Ann Surg. 2011 Apr;253(4):811-6
pubmed: 21475024
J Am Coll Surg. 2004 Jan;198(1):20-6
pubmed: 14698307
JAMA Surg. 2016 Dec 1;151(12):1157-1165
pubmed: 27653498
J Hosp Med. 2015 Jun;10(6):345-51
pubmed: 25873486
Med Care. 1992 Jul;30(7):615-29
pubmed: 1614231
Surgery. 2017 Mar;161(3):782-790
pubmed: 27788924
Am J Surg. 1980 Jul;140(1):144-50
pubmed: 7396078
Ann Surg. 2009 Dec;250(6):1029-34
pubmed: 19953723
Prehosp Emerg Care. 2014 Apr-Jun;18(2):163-73
pubmed: 24641269
Eff Clin Pract. 2000 Nov-Dec;3(6):284-9
pubmed: 11151525
J Hosp Med. 2016 Feb;11(2):136-44
pubmed: 26663904
J Trauma. 2008 Jul;65(1):34-41
pubmed: 18580517
JAMA Surg. 2017 Nov 1;152(11):1083-1084
pubmed: 28746704
J Crit Care. 2017 Feb;37:270-276
pubmed: 27612678
J Am Coll Surg. 2005 Sep;201(3):343-8
pubmed: 16125066
Biomed Res Int. 2014;2014:473419
pubmed: 24995300
JAMA. 2009 Dec 2;302(21):2323-9
pubmed: 19952319
Telemed J E Health. 2015 Aug;21(8):670-6
pubmed: 25885369
J Trauma. 2008 Feb;64(2):273-7; discussion 277-9
pubmed: 18301186
JAMA. 2000 Dec 6;284(21):2762-70
pubmed: 11105183
Ann Am Thorac Soc. 2014 Nov;11(9):1454-65
pubmed: 25296111
JAMA Surg. 2015 Nov;150(11):1023-4
pubmed: 26331677
JAMA. 2011 Jun 1;305(21):2175-83
pubmed: 21576622
Surgery. 2007 Oct;142(4):439-48; discussion 448-9
pubmed: 17950334
J Trauma. 2010 Sep;69(3):620-6
pubmed: 20093983
Chest. 2014 Apr;145(4):903-912
pubmed: 24687712
Prehosp Emerg Care. 2014;18 Suppl 1:25-34
pubmed: 24279813
Int J Nurs Stud. 2013 Oct;50(10):1351-8
pubmed: 23474081
J Hosp Med. 2013 May;8(5):236-42
pubmed: 23440923