Variability in management of blunt liver trauma and contribution of level of American College of Surgeons Committee on Trauma verification status on mortality

Christopher J. Tignanelli, Bellal A Joseph, Jill L. Jakubus, Gaby A. Iskander, Lena M. Napolitano, Mark R. Hemmila

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND Patients who sustain blunt liver trauma and are treated at an American College of Surgeons Committee on Trauma-verified Level I trauma center have an overall lower risk of mortality compared with patients admitted to a level II trauma center. However, elements contributing to these differences are unknown. We hypothesize that practice variation exists between trauma centers in management of blunt liver injury. Our objective is to identify practice variations and their effect on clinical outcomes. METHODS Data from a statewide collaborative quality initiative for trauma were used. The data set contains information from 29 American College of Surgeons Committee on Trauma verified Levels I and II trauma centers from 2011 to 2016. Propensity score matching was used to create cohorts of patients treated at Levels I or II trauma centers. The 1:1 matched cohorts were used to compare in-hospital mortality, management strategy, complications, intensive care unit (ICU) and hospital length of stay, and failure to rescue. RESULTS Four hundred fifty-four patients with grade 3 or higher blunt liver injury were included. Patients treated at level II trauma centers had higher in-hospital mortality than those treated at Level I trauma centers (15.4% vs 8.8%, p = 0.03). Level II trauma centers used angiography less compared with Level I centers (p = 0.007) and admitted significantly fewer patients to the ICU (p = 0.002). The ICU status was associated with reduced mortality (7.2% vs 23.9%, p < 0.001). Despite a lower rate of overall complications, Level II trauma centers were more likely to fail in rescuing their patients (p = 0.045). CONCLUSION Admission with a high-grade liver injury to a Level II trauma center is associated with increased in-hospital mortality. Level II trauma centers were less likely to use angiography or admit high-grade liver injuries to the ICU. This variation in practice may lead to the inability to rescue critically ill patients. Future research should investigate contributors to underutilization of resources for patients with high-grade liver injuries. Level of Evidence Care management, level IV

Original languageEnglish (US)
Pages (from-to)273-279
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume84
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Trauma Centers
Mortality
Liver
Wounds and Injuries
Intensive Care Units
Hospital Mortality
Nonpenetrating Wounds
Length of Stay
Angiography
Propensity Score
Critical Illness

Keywords

  • collaborative quality improvement
  • complications
  • Liver trauma
  • trauma designation status
  • trauma outcomes

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Variability in management of blunt liver trauma and contribution of level of American College of Surgeons Committee on Trauma verification status on mortality. / Tignanelli, Christopher J.; Joseph, Bellal A; Jakubus, Jill L.; Iskander, Gaby A.; Napolitano, Lena M.; Hemmila, Mark R.

In: Journal of Trauma and Acute Care Surgery, Vol. 84, No. 2, 01.02.2018, p. 273-279.

Research output: Contribution to journalArticle

Tignanelli, Christopher J. ; Joseph, Bellal A ; Jakubus, Jill L. ; Iskander, Gaby A. ; Napolitano, Lena M. ; Hemmila, Mark R. / Variability in management of blunt liver trauma and contribution of level of American College of Surgeons Committee on Trauma verification status on mortality. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 84, No. 2. pp. 273-279.
@article{7f766447ad994430807ae2fb99eedead,
title = "Variability in management of blunt liver trauma and contribution of level of American College of Surgeons Committee on Trauma verification status on mortality",
abstract = "BACKGROUND Patients who sustain blunt liver trauma and are treated at an American College of Surgeons Committee on Trauma-verified Level I trauma center have an overall lower risk of mortality compared with patients admitted to a level II trauma center. However, elements contributing to these differences are unknown. We hypothesize that practice variation exists between trauma centers in management of blunt liver injury. Our objective is to identify practice variations and their effect on clinical outcomes. METHODS Data from a statewide collaborative quality initiative for trauma were used. The data set contains information from 29 American College of Surgeons Committee on Trauma verified Levels I and II trauma centers from 2011 to 2016. Propensity score matching was used to create cohorts of patients treated at Levels I or II trauma centers. The 1:1 matched cohorts were used to compare in-hospital mortality, management strategy, complications, intensive care unit (ICU) and hospital length of stay, and failure to rescue. RESULTS Four hundred fifty-four patients with grade 3 or higher blunt liver injury were included. Patients treated at level II trauma centers had higher in-hospital mortality than those treated at Level I trauma centers (15.4{\%} vs 8.8{\%}, p = 0.03). Level II trauma centers used angiography less compared with Level I centers (p = 0.007) and admitted significantly fewer patients to the ICU (p = 0.002). The ICU status was associated with reduced mortality (7.2{\%} vs 23.9{\%}, p < 0.001). Despite a lower rate of overall complications, Level II trauma centers were more likely to fail in rescuing their patients (p = 0.045). CONCLUSION Admission with a high-grade liver injury to a Level II trauma center is associated with increased in-hospital mortality. Level II trauma centers were less likely to use angiography or admit high-grade liver injuries to the ICU. This variation in practice may lead to the inability to rescue critically ill patients. Future research should investigate contributors to underutilization of resources for patients with high-grade liver injuries. Level of Evidence Care management, level IV",
keywords = "collaborative quality improvement, complications, Liver trauma, trauma designation status, trauma outcomes",
author = "Tignanelli, {Christopher J.} and Joseph, {Bellal A} and Jakubus, {Jill L.} and Iskander, {Gaby A.} and Napolitano, {Lena M.} and Hemmila, {Mark R.}",
year = "2018",
month = "2",
day = "1",
doi = "10.1097/TA.0000000000001743",
language = "English (US)",
volume = "84",
pages = "273--279",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Variability in management of blunt liver trauma and contribution of level of American College of Surgeons Committee on Trauma verification status on mortality

AU - Tignanelli, Christopher J.

AU - Joseph, Bellal A

AU - Jakubus, Jill L.

AU - Iskander, Gaby A.

AU - Napolitano, Lena M.

AU - Hemmila, Mark R.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - BACKGROUND Patients who sustain blunt liver trauma and are treated at an American College of Surgeons Committee on Trauma-verified Level I trauma center have an overall lower risk of mortality compared with patients admitted to a level II trauma center. However, elements contributing to these differences are unknown. We hypothesize that practice variation exists between trauma centers in management of blunt liver injury. Our objective is to identify practice variations and their effect on clinical outcomes. METHODS Data from a statewide collaborative quality initiative for trauma were used. The data set contains information from 29 American College of Surgeons Committee on Trauma verified Levels I and II trauma centers from 2011 to 2016. Propensity score matching was used to create cohorts of patients treated at Levels I or II trauma centers. The 1:1 matched cohorts were used to compare in-hospital mortality, management strategy, complications, intensive care unit (ICU) and hospital length of stay, and failure to rescue. RESULTS Four hundred fifty-four patients with grade 3 or higher blunt liver injury were included. Patients treated at level II trauma centers had higher in-hospital mortality than those treated at Level I trauma centers (15.4% vs 8.8%, p = 0.03). Level II trauma centers used angiography less compared with Level I centers (p = 0.007) and admitted significantly fewer patients to the ICU (p = 0.002). The ICU status was associated with reduced mortality (7.2% vs 23.9%, p < 0.001). Despite a lower rate of overall complications, Level II trauma centers were more likely to fail in rescuing their patients (p = 0.045). CONCLUSION Admission with a high-grade liver injury to a Level II trauma center is associated with increased in-hospital mortality. Level II trauma centers were less likely to use angiography or admit high-grade liver injuries to the ICU. This variation in practice may lead to the inability to rescue critically ill patients. Future research should investigate contributors to underutilization of resources for patients with high-grade liver injuries. Level of Evidence Care management, level IV

AB - BACKGROUND Patients who sustain blunt liver trauma and are treated at an American College of Surgeons Committee on Trauma-verified Level I trauma center have an overall lower risk of mortality compared with patients admitted to a level II trauma center. However, elements contributing to these differences are unknown. We hypothesize that practice variation exists between trauma centers in management of blunt liver injury. Our objective is to identify practice variations and their effect on clinical outcomes. METHODS Data from a statewide collaborative quality initiative for trauma were used. The data set contains information from 29 American College of Surgeons Committee on Trauma verified Levels I and II trauma centers from 2011 to 2016. Propensity score matching was used to create cohorts of patients treated at Levels I or II trauma centers. The 1:1 matched cohorts were used to compare in-hospital mortality, management strategy, complications, intensive care unit (ICU) and hospital length of stay, and failure to rescue. RESULTS Four hundred fifty-four patients with grade 3 or higher blunt liver injury were included. Patients treated at level II trauma centers had higher in-hospital mortality than those treated at Level I trauma centers (15.4% vs 8.8%, p = 0.03). Level II trauma centers used angiography less compared with Level I centers (p = 0.007) and admitted significantly fewer patients to the ICU (p = 0.002). The ICU status was associated with reduced mortality (7.2% vs 23.9%, p < 0.001). Despite a lower rate of overall complications, Level II trauma centers were more likely to fail in rescuing their patients (p = 0.045). CONCLUSION Admission with a high-grade liver injury to a Level II trauma center is associated with increased in-hospital mortality. Level II trauma centers were less likely to use angiography or admit high-grade liver injuries to the ICU. This variation in practice may lead to the inability to rescue critically ill patients. Future research should investigate contributors to underutilization of resources for patients with high-grade liver injuries. Level of Evidence Care management, level IV

KW - collaborative quality improvement

KW - complications

KW - Liver trauma

KW - trauma designation status

KW - trauma outcomes

UR - http://www.scopus.com/inward/record.url?scp=85041596589&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041596589&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000001743

DO - 10.1097/TA.0000000000001743

M3 - Article

VL - 84

SP - 273

EP - 279

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2

ER -