• J Trauma Acute Care Surg · Jul 2012

    Injury profiles related to mortality in patients with a low Injury Severity Score: a case-mix issue?

    • Pieter Joosse, Niels W L Schep, J Carel Goslings, and Regional Trauma Network TraumaNet AMC Collaborators.
    • Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. p.joosse@amc.nl
    • J Trauma Acute Care Surg. 2012 Jul 1; 73 (1): 179-85.

    BackgroundOutcome prediction models are widely used to evaluate trauma care. External benchmarking provides individual institutions with a tool to compare survival with a reference dataset. However, these models do have limitations. In this study, the hypothesis was tested whether specific injuries are associated with increased mortality and whether differences in case-mix of these injuries influence outcome comparison.MethodsA retrospective study was conducted in a Dutch trauma region. Injury profiles, based on injuries most frequently endured by unexpected death, were determined. The association between these injury profiles and mortality was studied in patients with a low Injury Severity Score by logistic regression. The standardized survival of our population (Ws statistic) was compared with North-American and British reference databases, with and without patients suffering from previously defined injury profiles.ResultsIn total, 14,811 patients were included. Hip fractures, minor pelvic fractures, femur fractures, and minor thoracic injuries were significantly associated with mortality corrected for age, sex, and physiologic derangement in patients with a low injury severity. Odds ratios ranged from 2.42 to 2.92. The Ws statistic for comparison with North-American databases significantly improved after exclusion of patients with these injuries. The Ws statistic for comparison with a British reference database remained unchanged.ConclusionsHip fractures, minor pelvic fractures, femur fractures, and minor thoracic wall injuries are associated with increased mortality. Comparative outcome analysis of a population with a reference database that differs in case-mix with respect to these injuries should be interpreted cautiously.Level Of EvidencePrognostic study, level II.

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