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Defining "dead on arrival": impact on a level I trauma center
M D Pasquale1, M Rhodes, M D Cipolle
1Division of Trauma/Surgical Critical Care, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
Insights
Implementing "dead on arrival" (DOA) criteria in trauma centers can significantly reduce costs and resource burden. This study found that applying DOA criteria could save trauma centers substantial amounts annually.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Healthcare Management
Background:
- Trauma centers face significant resource allocation challenges.
- Defining clear criteria for "dead on arrival" (DOA) is crucial for efficient patient management.
- Prehospital cardiopulmonary resuscitation (CPR) practices impact resource utilization.
Purpose of the Study:
- To evaluate the financial and operational impact of implementing "dead on arrival" (DOA) criteria at a Level I trauma center.
- To assess the cost-effectiveness of applying established DOA criteria to trauma patients receiving prehospital CPR.
Main Methods:
- Retrospective review of trauma patients (1990-1994) who received prehospital CPR.
- Analysis of CPR timing, patient outcomes, and associated healthcare costs.
- Comparison of outcomes and costs with and without the application of DOA criteria.
Main Results:
- Of 106 patients receiving prehospital CPR, 20 did not meet DOA criteria, with 3 survivors (15%).
- 86 patients met DOA criteria; 16 were pronounced dead (costing $200/patient), while 70 underwent further resuscitation with no survivors (costing $4150/patient).
- Implementing DOA criteria demonstrated a 100% positive predictive value and potential 5-year cost savings of $290,000.
Conclusions:
- National DOA criteria can substantially decrease the burden on trauma centers.
- Estimated minimum annual savings for trauma centers could reach $14 million.
- Standardized DOA criteria improve resource allocation and reduce unnecessary medical interventions.
Objective:
To determine the potential impact of defining criteria for "dead on arrival" (DOA) on a Level I trauma center.
Methods:
From 1990 to 1994, trauma patients having cardiopulmonary resuscitation (CPR) performed by certified prehospital personnel were reviewed for time of CPR, outcome, and costs to determine whether any benefit would have been realized had DOA criteria been followed.
Results:
A total of 106 patients had prehospital CPR; 20 did not meet DOA criteria and underwent resuscitation, three survived (15%). Eighty-six patients met DOA criteria; 16 were pronounced dead without further resuscitative efforts (in-hospital costs of $200/patient), while 70 (81%) had continued resuscitation with no survivors (in-hospital costs of $4150/patient). The positive predictive value for criteria was 100%. Had criteria been implemented, total cost savings over the 5-year period would have been $290,000.
Conclusions:
National DOA criteria could dramatically reduce the burden on trauma centers with an estimated minimum annual savings of $14 million.