Age and preexisting conditions as risk factors for severe adverse events and failure to rescue after injury. J Surg Res 2016 Oct;205(2):368-377
Date
09/25/2016Pubmed ID
27664885Pubmed Central ID
PMC5119648DOI
10.1016/j.jss.2016.06.082Scopus ID
2-s2.0-84980334592 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
BACKGROUND: Failure to rescue (FTR: the conditional probability of death after complication) has been studied in trauma cohorts, but the impact of age and preexisting conditions (PECs) on risk of FTR is not well known. We assessed the relationship between age and PECs on the risk of experiencing serious adverse events (SAEs) subsequent FTR in trauma patients with the hypothesis that increased comorbidity burden and age would be associated with increased FTR.
MATERIALS AND METHODS: We performed a retrospective cohort analysis at an urban level 1 trauma center in Pennsylvania. All patients aged ≥16 y with minimum Abbreviated Injury Scale score ≥2 from 2009 to 2013 were included. Univariate logistic regression models for SAE and FTR were developed using age, PECs, demographics, and injury physiology. Variables found to be associated with the end point of interest (P ≤ 0.2) in univariate analysis were included in separate multivariable logistic regression models for each outcome.
RESULTS: SAE occurred in 1136 of 7533 (15.1 %) patients meeting inclusion criteria (median age 42 [interquartile range 26-59], 53% African-American, 72% male, 79% blunt, median ISS 10 [interquartile range 5-17]). Of those who experienced an SAE, 129 of 1136 patients subsequently died (FTR = 11.4%). Development of SAE and FTR was associated with age ≥ 70 y (odds ratio 1.58-1.78, 95% confidence interval 1.13-2.82). Renal disease was the only preexisting condition associated with both SAE and FTR.
CONCLUSIONS: Trauma patients with renal disease are mostly at increased risk for both SAE and FTR, but other PECs associated with SAE are not necessarily those associated with FTR. Future interventions designed to reduce FTR events should target this high-risk cohort.
Author List
Earl-Royal E, Kaufman EJ, Hsu JY, Wiebe DJ, Reilly PM, Holena DNAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Abbreviated Injury ScaleAdolescent
Adult
Age Factors
Aged
Aged, 80 and over
Comorbidity
Failure to Rescue, Health Care
Female
Hospital Mortality
Humans
Logistic Models
Male
Middle Aged
Pennsylvania
Registries
Retrospective Studies
Risk Factors
Trauma Centers
Wounds and Injuries
Young Adult
