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Related Experiment Videos

A new method for evaluating trauma centre outcome performance: TRAM-adjusted mortality estimates.

Lynne Moore1, James A Hanley, Alexis F Turgeon

  • 1Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada. lynne.moore.cha@ssss.gouv.qc.ca

Annals of Surgery
|April 17, 2010
PubMed
Summary

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A new method using the Trauma Risk Adjustment Model (TRAM) improves trauma center mortality evaluation by providing better risk adjustment and accounting for patient transfers. This approach allows for more accurate comparisons of institutional performance to enhance trauma care quality.

Area of Science:

  • Trauma care research
  • Health services research
  • Medical statistics

Background:

  • Standardized Mortality Ratios (SMRs) using Trauma and Injury Severity Score (TRISS) have limitations.
  • These limitations include inadequate risk adjustment, inappropriate comparison standards, and failure to account for hospital variations.

Purpose of the Study:

  • To develop an improved method for evaluating trauma center mortality.
  • The new method aims to address the shortcomings of existing TRISS SMR methodology.

Main Methods:

  • Developed a novel methodology using a provincial trauma registry with mandatory participation and standardized data.
  • Employed hierarchical logistic regression, incorporating the Trauma Risk Adjustment Model (TRAM) score, transfer status, and their interaction for risk adjustment.

Related Experiment Videos

  • Identified outliers by comparing individual hospital performance against all other centers.

    • Main Results:

    • The study analyzed 88,235 patients from 59 trauma centers, with a 5.4% mortality rate.
    • Crude mortality ranged from 1.3% to 14.3%, while TRAM-adjusted mortality estimates varied from 3.7% to 6.9%.
    • Identified three centers with significantly higher and one with significantly lower adjusted mortality compared to others.

    Conclusions:

    • The proposed method offers comprehensive risk adjustment, considers transfer status, and uses an internal standard for comparison.
    • It accounts for inter- and intrahospital variation, providing comparable regression-adjusted mortality estimates.
    • TRAM-adjusted mortality estimates are valuable for assessing institutional performance, identifying outliers, and improving trauma care quality.