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Failure to Rescue after Infectious Complications in a Statewide Trauma System
Elinore J Kaufman1, Emily Earl-Royal2, Philip S Barie1
11 Department of Surgery, New York-Presbyterian Weill Cornell Medical Center , New York, New York (formerly University of Pennsylvania Master's Program in Health Policy).
Background:
The failure to rescue (FTR) rate, the rate of death after a complication, measures a center's ability to identify and manage complications by "rescuing" vulnerable patients. Infectious complications are common after trauma, but risk factors for death after infection are not established. We hypothesized that risk factors would differ for FTR after infectious complications, development of infections, and for development of and death after non-infectious complications.
Patients And Methods:
We analyzed trauma registry data for adult patients admitted to all 30 level I and II Pennsylvania trauma centers, 2011-2014. We used multivariable regression to identify risk factors for infection, non-infectious complications, failure to rescue after infection (FTR-I), failure to rescue after non-infectious complications (FTR-N), and death. We compared secondary complication patterns among patients with an index infection.
Results:
Of 95,806 admitted patients, at least one complication developed in 11.2%. Among these, 33.6% had an infection as the first complication. Mortality rates were 3.7% overall, 2.8% in patients with no complications, 7.2% after infection, and 13.5% after non-infectious complications. Urinary tract infection was the most common infection (41.7%), followed by pneumonia (37.5%) and wound infection (6.9%). Risk factors for infection included higher injury severity score (ISS), poor admitting physiology, female gender, cirrhosis, dementia, history of stroke, and drug abuse. Factors associated with FTR-I included male gender (odds ratio [OR] 1.6, 95% confidence interval 1.1-1.2), older age (OR 1.04, 1.03-1.05), increased ISS, cirrhosis, chronic renal insufficiency, and use of anticoagulation or steroids.
Conclusions:
Infectious complications are common in trauma patients and are an important component of FTR. Risk factors for infection and FTR-I differ and may help identify patients who may benefit from close surveillance and early intervention. Half of all FTR deaths were preceded by only a single complication, highlighting that management of this index complication, along with any secondary complications, may be a fruitful area for intervention.
Insights
Failure to rescue (FTR) after trauma complications is critical. Risk factors for infection and FTR differ, guiding targeted interventions for better patient outcomes in trauma care.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Infectious Diseases
Background:
- Failure to rescue (FTR) quantifies mortality post-complication, reflecting a center's patient management capabilities.
- Infectious complications are frequent in trauma patients, yet specific risk factors for mortality post-infection remain unclear.
- This study investigates distinct risk factors for FTR following infectious versus non-infectious complications in trauma.
Purpose of the Study:
- To identify risk factors for developing infections after trauma.
- To determine risk factors for failure to rescue (FTR) after infectious complications (FTR-I).
- To compare these factors with those for non-infectious complications and associated FTR (FTR-N).
Main Methods:
- Analysis of adult trauma patient data from Pennsylvania trauma centers (2011-2014).
- Multivariable regression models used to identify risk factors for infection, FTR-I, FTR-N, and death.
- Comparison of secondary complication patterns in patients with initial infections.
Main Results:
- Infection was the initial complication in 33.6% of patients with complications (n=95,806).
- Mortality was 7.2% after infection and 13.5% after non-infectious complications.
- Risk factors for FTR-I included male gender, older age, higher injury severity, cirrhosis, renal insufficiency, and steroid/anticoagulant use.
Conclusions:
- Infectious complications significantly contribute to FTR in trauma patients.
- Distinct risk factors for infection and FTR-I necessitate tailored surveillance and early intervention strategies.
- Managing index complications is crucial, as half of FTR deaths followed a single initial complication.
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