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Failure to rescue as a center-level metric in pediatric trauma

Lucy W Ma1, Justin S Hatchimonji2, Elinore J Kaufman3

  • 1College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA.

Surgery
|May 11, 2019
PubMed

Insights

Failure to rescue, defined as death after a complication, is low in pediatric trauma care. However, higher complication and failure to rescue rates were observed at high-mortality centers, suggesting areas for quality improvement.

Area of Science:

  • Pediatric Trauma Care
  • Quality Improvement Metrics
  • Patient Safety

Background:

  • Failure to rescue (FTR) is a measure of care quality in adult trauma, defined as death following a complication.
  • No prior studies have evaluated FTR in pediatric trauma patients.
  • This study aims to define the relationship between mortality, complications, and FTR in pediatric trauma centers.

Purpose of the Study:

  • To investigate the association between mortality rates, complication rates, and failure to rescue (FTR) rates in pediatric trauma centers.
  • To establish the utility of FTR as a quality metric for pediatric trauma care.
  • To identify potential areas for improving outcomes in pediatric trauma patients.

Main Methods:

  • Retrospective cohort study using the 2015-2016 National Trauma Data Bank.
  • Included pediatric patients (<18 years) with Injury Severity Score (ISS) ≥9.
  • Excluded centers with <50 pediatric patients or no reported complications; analyzed complication, FTR, mortality, and precedence rates by center, comparing tertiles of mortality.

Main Results:

  • Overall complication rate was 4% (2,204/62,190 patients) and FTR rate was 5% (120 deaths post-complication).
  • High-mortality centers exhibited significantly higher FTR rates (10% vs. 0.6%) and complication rates (5% vs. 4%) compared to low-mortality centers.
  • Overall precedence rate was 15%.

Conclusions:

  • While overall complication and FTR rates are low in pediatric trauma, higher rates at high-mortality centers indicate potential quality variations.
  • Low overall complication and precedence rates may limit the current utility of FTR as a center-level metric for pediatric trauma.
  • Further investigation into individual FTR cases is warranted to identify specific opportunities for care improvement in pediatric trauma.
Abstract

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