Developing a measure of overall intensity of injury care: A latent class analysis. J Trauma Acute Care Surg 2022 Jan 01;92(1):193-200
Date
07/06/2021Pubmed ID
34225349Pubmed Central ID
PMC8692337DOI
10.1097/TA.0000000000003321Scopus ID
2-s2.0-85122289509 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: While injury is a leading cause of death and debility in older adults, the relationship between intensity of care and trauma remains unknown. The focus of this analysis is to measure the overall intensity of care delivered to injured older adults during hospitalization.
METHODS: We used Centers for Medicare and Medicaid Services Medicare fee-for-service claims data (2013-2014), to identify emergency department-based claims for moderate and severe blunt trauma in age-eligible beneficiaries. Medical procedures associated with care intensity were identified using a modified Delphi method. A latent class model was estimated using the identified procedures, intensive care unit length of stay, demographics, and injury characteristics. Clinical phenotypes for each class were explored.
RESULTS: A total of 683,398 cases were classified as low- (73%), moderate- (23%), and high-intensity care (4%). Greater age and reduced injury severity were indicators of lower intensity, while males, non-Whites, and nonfall mechanisms were more common with high intensity. Intubation/mechanical ventilation was an indicator of high intensity and often occurred with at least one other procedure or an extended intensive care unit stay.
CONCLUSION: This work demonstrates that, although heterogeneous, care for blunt trauma can be evaluated using a single novel measure.
LEVEL OF EVIDENCE: For prognostic/epidemiological studies, level III.
Author List
Zebrowski AM, Hsu JY, Holena DN, Wiebe DJ, Carr BGAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedCritical Care
Delphi Technique
Female
Humans
Insurance Claim Review
Intensive Care Units
Length of Stay
Male
Medicare
Trauma Severity Indices
United States
Wounds, Nonpenetrating
