High-Performance Trauma Centers in a Single-State Trauma System : Big Saves or Marginal Gains?


It remains unknown whether improvements in the observed:expected (O:E) mortality ratios of trauma centers are due to a small number of unexpected survivors with high mortality risk or a larger number of unexpected survivors with moderate mortality risk. In a recent study led by Justin Hatchimonji, MD, in collaboration with PISC Senior Scholar Daniel Holena, MD, and more, They calculated O:E ratios for trauma centers in Pennsylvania for 2016 using a risk-adjusted mortality model. There was no difference found in survival between high performing and low performing centers in patients with an expected mortality of <10% or ≥70%. Though patients with very low predicted mortality do equally well in high-performing and low-performing centers, the fact that performance seems determined by outcomes of patients with moderate predicted mortality favors a "marginal gains" theory.

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