Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2012 May;255(5):993-9.
doi: 10.1097/SLA.0b013e31824f1ebc.

Benchmarking outcomes in the critically injured trauma patient and the effect of implementing standard operating procedures

Joseph Cuschieri  1 , Jeffrey L Johnson, Jason Sperry, Michael A West, Ernest E Moore, Joseph P Minei, Paul E Bankey, Avery B Nathens, Alex G Cuenca, Philip A Efron, Laura Hennessy, Wenzhong Xiao, Michael N Mindrinos, Grace P McDonald-Smith, Philip H Mason, Timothy R Billiar, David A Schoenfeld, H Shaw Warren, J Perren Cobb, Lyle L Moldawer, Ronald W Davis, Ronald V Maier, Ronald G Tompkins; Inflammation and Host Response to Injury, Large Scale Collaborative Research Program
Collaborators, Affiliations
Multicenter Study

Benchmarking outcomes in the critically injured trauma patient and the effect of implementing standard operating procedures

Joseph Cuschieri et al. Ann Surg. 2012 May.

Abstract

Objective: To determine and compare outcomes with accepted benchmarks in trauma care at 7 academic level I trauma centers in which patients were treated on the basis of a series of standard operating procedures (SOPs).

Background: Injury remains the leading cause of death for those younger than 45 years. This study describes the baseline patient characteristics and well-defined outcomes of persons hospitalized in the United States for severe blunt trauma.

Methods: We followed 1637 trauma patients from 2003 to 2009 up to 28 hospital days using SOPs developed at the onset of the study. An extensive database on patient and injury characteristics, clinical treatment, and outcomes was created. These data were compared with existing trauma benchmarks.

Results: The study patients were critically injured and were in shock. SOP compliance improved 10% to 40% during the study period. Multiple organ failure and mortality rates were 34.8% and 16.7%, respectively. Time to recovery, defined as the time until the patient was free of organ failure for at least 2 consecutive days, was developed as a new outcome measure. There was a reduction in mortality rate in the cohort during the study that cannot be explained by changes in the patient population.

Conclusions: This study provides the current benchmark and the overall positive effect of implementing SOPs for severely injured patients. Over the course of the study, there were improvements in morbidity and mortality rates and increasing compliance with SOPs. Mortality was surprisingly low, given the degree of injury, and improved over the duration of the study, which correlated with improved SOP compliance.

Trial registration: ClinicalTrials.gov NCT00257231.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Mortality
Patients divided into quintiles in Panels B, C, and D based underlying score or injury severity. Panel A shows mortality over the entire study period. Observed (solid lines) vs. expected (dashed line) outcome for Panel B) mortality by TRISS (p<0.001), Panel C) mortality by APACHE II (p<0.001), and Panel D) mortality by NTDB (p<0.001).
Figure 1
Figure 1. Mortality
Patients divided into quintiles in Panels B, C, and D based underlying score or injury severity. Panel A shows mortality over the entire study period. Observed (solid lines) vs. expected (dashed line) outcome for Panel B) mortality by TRISS (p<0.001), Panel C) mortality by APACHE II (p<0.001), and Panel D) mortality by NTDB (p<0.001).
Figure 1
Figure 1. Mortality
Patients divided into quintiles in Panels B, C, and D based underlying score or injury severity. Panel A shows mortality over the entire study period. Observed (solid lines) vs. expected (dashed line) outcome for Panel B) mortality by TRISS (p<0.001), Panel C) mortality by APACHE II (p<0.001), and Panel D) mortality by NTDB (p<0.001).
Figure 1
Figure 1. Mortality
Patients divided into quintiles in Panels B, C, and D based underlying score or injury severity. Panel A shows mortality over the entire study period. Observed (solid lines) vs. expected (dashed line) outcome for Panel B) mortality by TRISS (p<0.001), Panel C) mortality by APACHE II (p<0.001), and Panel D) mortality by NTDB (p<0.001).
Figure 2
Figure 2. Time to Recovery
Panel A shows time to recovery from MOF. Heat map of the MOF scores over time after injury up to 28 days for each of the 1,637 massive injured patients. From top to bottom, patients are ordered according to their TTR days. Panel B shows mortality and time to recovery following severe injury. Kaplan-Meier survival curve and proportion of patients fully recovered from organ dysfunction in the first 28 days following blunt traumatic injury.
Figure 2
Figure 2. Time to Recovery
Panel A shows time to recovery from MOF. Heat map of the MOF scores over time after injury up to 28 days for each of the 1,637 massive injured patients. From top to bottom, patients are ordered according to their TTR days. Panel B shows mortality and time to recovery following severe injury. Kaplan-Meier survival curve and proportion of patients fully recovered from organ dysfunction in the first 28 days following blunt traumatic injury.
See this image and copyright information in PMC

References

    1. Health, United States, 2008 with Chartbook. Hyattsville, Md: National Center for Health Statistics; 2009.
    1. Heron M, Hoyert DL, Murphy SL, Xu J. National vital statistics reports 2009. 14. Vol. 57. Hyattsville, Md: National Center for Health Statistics; 2009. Deaths: Final data for 2006. - PubMed
    1. Bergen G, Chen LH, Warner M, Fingerhut LA. Injury in the United States: 2007 Chartbook. Hyattsville, Md: National Center for Health Statistics; 2007.
    1. Evans JA, Van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg. 2010 Jan;34(1):158–63. - PubMed
    1. Dewar D, Moore FA, Moore EE, Balogh Z. Postinjury multiple organ failure. Injury. 2009 Sep;40(9):912–8. - PubMed

Publication types

Associated data