Introduction
An unconscionably large number of admissions die in hospitals. The first attempt to quantify this occurred in 1999 when, at the instigation of a presidential task force, the Institute of Medicine extrapolated findings from three states to estimate that from 44,000 to 98,000 people are killed each year by medical errors while confined. A study by Zhan and Miller that examined 7.5 million patient records covering 28 states and spanning a year gave credence to these estimates. In 2004, the HealthGrades health quality institute suggested after investigating three years of Medicare data representing about half of confined patients from everywhere in the nation (excluding obstetric admissions) that: a) either the two earlier studies had grossly underestimated the preventable death rate; or, b) the death rate from medical errors has risen rapidly and abruptly. The new HealthGrades estimate: an average of 195,000 avoidable deaths each year from 2000 to 2002. The company wryly noted this was worse than any epidemic, being equivalent to 390 747 airliners packed full of passengers (American Iatrogenic Association, 2009).
In turn, the Centers for Disease Control and Prevention went on record that 2 million people are infected while hospitalized and 90,000 of these patients die. The principal culprit: antibiotic-resistant staphylococcus bacteria borne by unwashed hands of healthcare staff, improperly sterilized equipment and rooms.
The Research in Question
Yet another class of preventable deaths consists of trauma victims usually first seen in hospital emergency rooms. In an ideal world, a Consultant-level trauma team would constantly be on standby in the Emergency Room prepared to deal instantly with trauma victims as they are carried through the door. But such expert physicians are also needed elsewhere for rounds, to administer critical treatment or do surgery.
The other concern, a team of physicians at the USC Department of Medicine in Los Angeles and Arrowhead Regional Medical Center in Colton (CA) realized, was the sheer diversity of criteria used to determine whether the gravity of the trauma victim’s condition necessitated trauma team intervention without generating too many false positives. Traditionally, the warning tools had included an assessment of the injury type (blunt versus penetrating), anatomical location, patient physiological markers, a “Revised Trauma Score” checklist formulated by the Committee on Trauma of the American College of Surgeons, the Glasgow Coma Scale, and the extent of damage suffered by the vehicles (if a car accident or crash was involved). Obviously, Emergency Room staff receiving a radioed alert needed a screening criterion simple enough for ambulance paramedics to undertake and reliable enough to reduce the incidents of patient mortality due to delayed arrival or neglect by the trauma team.
Statistical Analysis in Use
The USC-Arrowhead team investigated the utility of employing systolic blood pressure to classify incoming patients as low- or high-risk. A retrospective study of 6,964 patients that comprised the “universe” of admissions over a five-year span in the trauma registry of both institutions was examined. The research team examined blood pressure readings at both the pre-hospital (PH) and on arrival at the Emergency Department (ED) stages. On querying the data and calculating odds ratios for eventual mortality across four classes of hypotensive patients, the researchers found that the highest risk of expiring while in the hospital existed among patients whose systolic blood pressure while in transit was 80 mmHg or lower and 90 mmHg on arriving at the ED (50% mortality, Lalezarzadeh, Wisniewski, Huynh, Loza, and Gnanadev, 2009).
Conclusion
Just like the case of odds ratios when calculated for incidence of moderate-heavy smokers contracting lung cancer, the present by no means determines a cause-and-effect relationship. Rather, the finding of systolic blood pressure below certain benchmark levels is a marker of other injuries or precipitating factors (e.g. massive internal bleeding) that worsen the patient’s chances of survival unless the trauma team is ready to intervene in determined fashion once he arrives in the ED.
References
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Lalezarzadeh, F., Wisniewski, P., Huynh, K. Loza, M., & Gnanadev, D. (2009). Evaluation of prehospital and emergency department systolic blood pressure as a predictor of in-hospital mortality. The American Surgeon, 75 (10) 1009-1014.
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