In adult trauma patients, high and low-mortality trauma hospitals have similar rates of major complications but differ based on failure-to-rescue (mortality following a major complication), which has become a marker of hospital quality. A study published in the Journal of Trauma and Acute Care Surgery, sought to examine whether failure-to-rescue is also an appropriate hospital quality indicator in pediatric trauma. Children under the age of 15 were identified in the 2007-2014 National Trauma Databank research datasets. Hospitals were classified as a high, average or low-mortality based on risk-adjusted observed-to-expected in-hospital mortality ratios using the modified Trauma Mortality Probability Model. The study found for pediatric trauma patients, mortality is more strongly associated with major complication rate than with failure-to-rescue. Thus, failure-to-rescue does not appear to be the key driver of hospital quality in this population as it does in the adult trauma population.
- The Value of Failure-to-Rescue in Determining Hospital Quality for Pediatric Trauma. Journal of Trauma & Acute Care Surgery. March 2019