Faculty Collaboration Database

Excess mortality caused by medical injury. Ann Fam Med 2006;4(5):410-6

Date

09/28/2006

Pubmed ID

17003140

Pubmed Central ID

PMC1578648

DOI

10.1370/afm.553

Scopus ID

2-s2.0-33749647007 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

PURPOSE: We wanted to estimate excess risk of in-hospital mortality associated with medical injuries identified using an injury surveillance system, after controlling for risk of death resulting from comorbidities.

METHODS: The Wisconsin Medical Injuries Prevention Program (WMIPP) screening criteria were used to identify medical injuries, defined as "any untoward harm associated with a therapeutic or diagnostic healthcare intervention," among discharge diagnoses for all 562,317 patients discharged from 134 acute care hospitals in Wisconsin in 2002. We then derived estimates for crude and adjusted relative risk of in-hospital mortality associated with the presence of a medical injury diagnosis. Logistic regression adjusted for baseline risk of mortality using a comorbidity index, age, sex, Diagnosis Related Groups, hospital characteristics, and clustering within hospital.

RESULTS: There were 77,666 discharges that met WMIPP criteria for at least 1 medical injury (13.8%). Crude risk ratios for death ranged from 1.27 to 2.4 for those with medical injuries within 1 of 4 categories: drugs/biologics; devices, implants, and grafts; procedures; and radiation. After adjustment, estimates of excess mortality decreased, and significance persisted only for injuries related to procedures (39%; 95% confidence interval [CI], 28%-52%) and devices, implants, and grafts (16%; 95% CI, 3%-30%).

CONCLUSIONS: Estimates of excess mortality that do not account for baseline mortality risk may be exaggerated. Findings have implications for the care family physicians provide in the hospital and for the advice they give their patients who are concerned about the risks of hospitalization.

Author List

Meurer LN, Yang H, Guse CE, Russo C, Brasel KJ, Layde PM

Author

Linda N. Meurer MD, MPH Professor in the Family Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Child
Comorbidity
Female
Hospital Mortality
Humans
Logistic Models
Male
Medical Errors
Medication Errors
Middle Aged
Odds Ratio
Quality of Health Care
Risk Assessment
Severity of Illness Index
Wisconsin