Age and preexisting conditions as risk factors for severe adverse events and failure to rescue after injury.
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.



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.



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.



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.
Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California.
Emily
E
Earl-Royal
Department of Surgery, New York-Presbyterian Hospital Weill Cornell Medical Center, New York, New York.
Elinore J
EJ
Kaufman
The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Jesse Y
JY
Hsu
The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; The Leonard Davis Institute, Wharton School of Business at the University of Pennsylvania, Philadelphia, Pennsylvania.
Douglas J
DJ
Wiebe
Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Patrick M
PM
Reilly
The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; The Leonard Davis Institute, Wharton School of Business at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: daniel.holena@uphs.upenn.edu.
Daniel N
DN
Holena
D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D000067248:Failure to Rescue, Health Care / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D055815:Young Adult
Aged; Cohort studies; Comorbidity; Fatal outcome; Postoperative complications; Wounds and injuries
J Trauma Acute Care Surg. 2014 Mar;76(3):894-901
24553567
Int J Qual Health Care. 1997 Jun;9(3):193-200
9209916
Med Care. 1997 Oct;35(10 Suppl):OS77-92
9339779
J Trauma. 2001 Oct;51(4):754-6; discussion 756-7
11586171
J Trauma. 2006 Nov;61(5):1255-60
17099538
Ann Surg. 2010 Aug;252(2):358-62
20622658
J Trauma Acute Care Surg. 2015 Feb;78(2):312-7
25757116
Med Care. 1992 Jul;30(7):615-29
1614231
Ann Surg. 2011 Apr;253(4):811-6
21475024
Anesthesiology. 2002 May;96(5):1044-52
11981141
J Nurs Scholarsh. 2005;37(4):361-6
16396410
J Trauma. 1990 Dec;30(12):1476-82
2258958
Injury. 2010 Sep;41(9):886-93
20542270
J Trauma. 1998 Oct;45(4):805-10
9783625
Ann Surg. 2005 Sep;242(3):326-41; discussion 341-3
16135919
JAMA. 1995 Jul 26;274(4):317-23
7609261
J Trauma. 1999 Apr;46(4):702-6
10217237
Health Serv Res. 2013 Oct;48(5):1684-703
23662602
BJU Int. 2015 Apr;115(4):666-74
24913548
J Trauma. 2002 Feb;52(2):242-6
11834982
J Vasc Surg. 2014 Dec;60(6):1473-80
25441676
J Trauma. 1992 Feb;32(2):236-43; discussion 243-4
1740808
J Trauma. 2011 Mar;70(3):575-82
21610345
J Trauma. 2004 Apr;56(4):760-7
15187738
Am J Public Health. 1989 Sep;79(9):1278-82
2764207
JAMA Surg. 2014 Aug;149(8):766-72
24920308
JAMA Surg. 2014 Apr;149(4):319-26
24452778
J Trauma. 1989 Jun;29(6):757-64; discussion 764-5
2738973
Eur J Trauma Emerg Surg. 2017 Feb;43(1):121-127
26510941
Surgery. 2005 Nov;138(5):837-43
16291383
J Trauma. 1992 Sep;33(3):440-4
1404516
Annu Proc Assoc Adv Automot Med. 2003;47:561-76
12941251
J Vasc Surg. 2015 Feb;61(2):324-31
25312534
J Orthop Trauma. 2015 Mar;29(3):e96-102
25233165
J Thorac Cardiovasc Surg. 2015 May;149(5):1365-71; discussion 1371-3.e3
25791948
J Am Coll Surg. 2010 Sep;211(3):325-30
20800188
World J Surg. 1996 Oct;20(8):1113-9; discussion 1119-20
8798374
JAMA. 2003 Sep 24;290(12):1617-23
14506121
JAMA Surg. 2014 Feb;149(2):119-23
24336902
Arch Surg. 2012 Feb;147(2):152-8
22351910
Accid Anal Prev. 2008 Jul;40(4):1498-505
18606283
Ann Surg Innov Res. 2014 Dec 19;8(1):9
25550708
J Trauma Acute Care Surg. 2012 Jan;72(1):112-8
22310124
JAMA. 1990 Apr 11;263(14):1942-6
2313871
J Burn Care Res. 2015 Jan-Feb;36(1):193-6
25559732
J Am Coll Surg. 2014 Nov;219(5):1020-7
25260686
J Clin Oncol. 2012 Nov 10;30(32):3976-82
23032619
Adv Surg. 2010;44:229-49
20919524