Exploring the Failure-to-Rescue Concept for Pediatric Trauma Patients
Eric H. Rosenfeld, M.D., M.P.H. ; Wei Zhang, Ph.D.; Brittany Johnson, MD; Sohail R. Shah, M.D., M.S.H.A.; Adam M. Vogel, M.D.; Bindi Naik-Mathuria, M.D., M.P.H.
Baylor College of Medicine/Texas Children's Hospital, Houston, TX
Background: In adult trauma patients, it has been shown that high and low-mortality trauma hospitals have similar rates of major complications but differ based on the failure-to-rescue rate (mortality following a major complication), which has become a marker of hospital quality. The aim of this study is to examine whether failure-to-rescue is also a hospital quality indicator in pediatric trauma.
Methods: Children<15 were identified in the 2007-2014 National Trauma Databank research datasets. Hospitals were classified as a high, average or low-mortality based on risk-adjusted observed-to-expected in-hospital mortality ratios using the modified Trauma Mortality Probability Model. Regression modeling was used to explore the impact of hospital quality ranking on the incidence of major complications and failure-to-rescue. Major complications studied were sepsis, coagulopathy, cardiac arrest, pneumonia, acute respiratory distress syndrome, pulmonary embolism, stroke and myocardial infarct.
Results: Of the 125,057 children, 31,600 were treated at low-mortality hospitals, 86,443 at average, and 7,014 at high-mortality hospitals. Low-mortality hospitals had a lower rate of complications [0.5% (low) vs. 0.9% (avg) vs. 0.8% (high); adjusted OR 0.71; 95%CI 0.61,0.83] and a lower failure-to-rescue rate compared to average and high-mortality hospitals [adjusted OR 0.53 (high; 95% CI 0.34-0.83) and 1.46 (average;95% CI 1.04-2.04)]. There was no correlation between trauma verification level and hospital mortality status based on the model.
Conclusion: For pediatric trauma patients, mortality is associated with both major complications and failure-to-rescue rates. The failure-to-rescue concept does not appear to be the major driver of hospital quality in this population.
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