Accurate ID of nonsalvageable trauma patients improves trauma center performance metrics

Byrne et al.’s study evaluating three criteria for identifying unsalvageable trauma patients demonstrates the critical role that high-quality data can play in quality improvement efforts. Using data from the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP), they developed a proxy measure that resulted in less than 1% of patients being incorrectly classified as unsalvageable.

Having an accurate, easy-to-calculate model for predicting survival is essential in applying these findings at the point of care, as the decision of whether or not to perform a resuscitative thoracotomy must be made expediently. An accurate model also allows resources to be concentrated on those who might derive the most benefit and minimizes the known harms, particularly to health care providers, and costs associated with resuscitative thoracotomies. Finally, an accurate model is necessary to ensure that benchmarking accurately reflects quality of care rather than case mix, and that efforts are appropriately directed toward those centers whose adjusted mortality is above expected, whether or not they are outliers.

Future efforts should be directed toward evaluating whether implementation of this proxy measure into clinical practice improves not just survival but survival with good functional status at a longer term end point.

Dr. Lillian S. Kao is an ACS Fellow and associate professor of surgery at the University of Texas Health Science Center at Houston.