Benchmarking Outcomes in the Critically Injured Trauma Patient and the Effect of Implementing Standard Operating Procedures

Abstract

Objective To determine and compare outcomes with accepted benchmarks in trauma care at seven academic Level I trauma centers in which patients were treated based on a series of standard operating procedures (SOPs). Background Injury remains the leading cause of death for those under 45 years of age. We describe the baseline patient characteristics and well-defined outcomes of persons hospitalized in the United States for severe blunt trauma. Methods We followed 1,637 trauma patients from 2003–2009 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 in shock. SOP compliance improved 10–40% 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 two 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 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.

Genomic responses in mouse models poorly mimic human inflammatory diseases

“…amounts of blood received (total transfusion in milliliters; M = 1,900, MQ = 1,050-3,000), and patient clinical outcomes as indicated by survival (96%), multiorgan failure (maximum Marshall score; M = 5, MQ = 3-7), time to recovery (days; M = 7, MQ = 4-15), nosocomial infections (54.5%), and hospital length of stay (days; M = 21, MQ = 12-32) (15,21). Similarly, in the burn patient population, significant variations existed in the extent of burn injuries, for example, in terms of total body surface area of burns (TBSA; M = 53%, MQ = 32-74%), percentages of flame burns (86%) and inhalation injury (52%), and survival (85%).…”

Development of a Genomic Metric that can be Rapidly Used to Predict Clinical Outcome in Severely Injured Trauma Patients

“…Using clinical parameters, the 167 enrolled patients were divided into three cohorts based on their time to organ recovery (TTR), a new metric of organ failure recovery recently described by our group, which is defined as the time at which a patient is free from organ failure for at least two days. Prolonged TTR is associated with advanced age, increased severity of injury, shock, and increased transfusion requirements, thus making it a comprehensive metric to monitor the complex response in trauma patients (22). This allowed us to divide the cohort into three distinct groups of patients who had either an uncomplicated, intermediate, or complicated recovery, as defined in the Materials and Methods (Table 1 and 2).…”

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

“…This may not be surprising given that the population studied comprised a cohort of critically injured patients admitted in shock. The critical nature of the population is supported further by the significantly higher AIS, NISS, Marshall and Denver scores, which combined, represent markers associated with increased critical illness, prolonged time to recovery [19], worsening immune dysfunction [24][25][26][27], increased mortality, and worse clinical outcomes overall [19,28]. Marshall and Denver scores are measurements used to evaluate multiple-organ dysfunction syndrome that have been valid and are indicators of adverse outcomes in critical illness [29].…”

“…Background for this includes studies on posttransplant patients with active immunosuppression as well as patients undergoing oncologic therapy who are at increased risk for CDI despite the lack of exposure to antimicrobial [6]. Co-morbidities known to affect the immune response have also been shown to be associated with C. difficile [17,19], which may explain the increased risk in the aging population, which is known to undergo immunosenescence [16,20]. In addition, specific genetic polymorphisms have been shown to be associated with increased risk for development of primary infection with C. difficile, as well as recurrences [12,14,[21][22][23].…”