Benchmarking the incidence of organ failure after injury at trauma centers and nontrauma centers in the United States

Abstract

Organ failure after injury is a significant cause of morbidity and mortality, yet its true incidence is unknown. We sought to benchmark the incidence of organ failure following injury at trauma centers and nontrauma centers using a nationally representative sample of hospital discharges. We hypothesized that injured patients receiving care at trauma centers would have a lower incidence of organ failure than those at nontrauma centers. We used the 2006 Nationwide Inpatient Sample to identify injured adults (age ≥ 15 years) with organ dysfunction using specific DRG International Classification of Diseases-9th Rev. codes by system. After adjusting for hospital size, geographic region, comorbidities, Injury Severity Score (ISS), age, and sex, a multivariate logistic regression model was created to compare rates of organ dysfunction between trauma centers and nontrauma centers. We identified 396,276 injured patients, representing the patient care experience of a total of 1,939,473 patients. Among these patients, 6.5% had concurrent organ failure. Injured patients who had acute organ failure were more likely to die than injured patients without organ failure (12.4% vs. 1.7%, p < 0.001). Mortality increased with the number of organ system failures. Patients treated at trauma centers had a higher incidence of respiratory and cardiac failure compared with nontrauma centers. We offer the first national benchmark of rates of acute organ failure among injured patients. Postinjury organ failure is uncommon, but incidence increases with injury severity and correlates with mortality. Patients at trauma centers had higher rates of respiratory and cardiac failure, possibly representing differences in referral patterns or resuscitation strategies. Prognostic and epidemiologic study, level III.