Definition of mortality for trauma center performance evaluation: a comparative study

Area of Science:

• Trauma Care Quality Assessment
• Health Services Research
• Geriatric Medicine

Background:

• Mortality metrics are vital for evaluating trauma care quality.
• A lack of consensus exists regarding the optimal definition of mortality for performance evaluation.
• Patient age significantly influences mortality patterns and outcomes in trauma care.

Purpose of the Study:

• To assess how different definitions of mortality (place and time of death) impact trauma center performance evaluations.
• To analyze these impacts across various age groups, focusing on elderly populations.
• To determine the necessary timeframe for mortality data collection for accurate performance assessment.

Main Methods:

• Multicenter retrospective cohort study utilizing Canadian provincial trauma system data (1999-2006).
• Inclusion of 47,261 adult trauma patients with severe injuries (Abbreviated Injury Scale score ≥3).
• Linking trauma registry data with vital statistics to capture mortality up to 12 months post-admission, stratified by age groups (16-64, 65-84, ≥85 years).

Main Results:

• Significant variations in trauma center performance evaluations were observed based on mortality definitions, particularly for patients aged 65 years and older.
• In younger adults (16-64 years), 30-day in-hospital mortality represented 83% of all deaths, with high agreement across mortality definitions (>0.9).
• In older adults (65-84 years), 30-day in-hospital mortality accounted for only 52% of deaths, with observed mortality reaching expected rates around 6 months and low agreement across definitions.

Conclusions:

• Performance evaluation results for trauma care vary considerably depending on the definition of mortality used, especially for elderly patients.
• A substantial proportion of deaths in older adults occur beyond 30 days post-admission, including post-discharge deaths.
• Accurate performance evaluation of trauma centers including elderly patients necessitates incorporating post-discharge mortality data up to six months post-admission.