Journal of Emergencies, Trauma, and Shock
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 
Users online:656   Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size   
ORIGINAL ARTICLE
Year : 2012  |  Volume : 5  |  Issue : 4  |  Page : 333-337

Comparing regression-adjusted mortality to standardized mortality ratios for trauma center profiling


1 Department of Epidemiology and Biostatistics. McGill University, Montreal, Canada
2 Unité de traumatologie-urgence-soins intensifs, Centre de Recherche du CHA (Hôpital de l'Enfant-Jésus), Université Laval; Département d'anesthésiologie, Division de soins intensifs, Hôpital de l'Enfant-Jésus, Université Laval, Quebec City, Quebec, Canada
3 Unité de traumatologie-urgence-soins intensifs, Centre de Recherche du CHA (Hôpital de l'Enfant-Jésus), Université Laval, Canada

Correspondence Address:
Lynne Moore
Department of Epidemiology and Biostatistics. McGill University, Montreal
Canada
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.102404

Rights and Permissions

Background: Trauma center profiling is commonly performed with Standardized Mortality Ratios (SMRs). However, comparison of SMRs across trauma centers with different case mix can induce confounding leading to biased trauma center ranks. We hypothesized that Regression-Adjusted Mortality (RAM) estimates would provide a more valid measure of trauma center performance than SMRs. Objective: Compare trauma center ranks generated by RAM estimates to those generated by SMRs. Materials and Methods: The study was based on data from a provincial Trauma Registry (1999-2006; n = 88,235). SMRs were derived as the ratio of observed to expected deaths using: (1) the study population as an internal standard, (2) the US National Trauma Data Bank as an external standard. The expected death count was calculated as the sum of mortality probabilities for all patients treated in a hospital conditional on the injury severity score, the revised trauma score, and age. RAM estimates were obtained directly from a hierarchical logistic regression model. Results: Crude mortality was 5.4% and varied between 1.3% and 13.5% across the 59 trauma centers. When trauma center ranks from internal SMRs and RAM were compared, 49 out of 59 centers changed rank and six centers changed by more than five ranks. When trauma center ranks from external SMRs and RAM were compared, 55 centers changed rank and 17 changed by more than five ranks. Conclusions: The results of this study suggest that the use of SMRs to rank trauma centers in terms of mortality may be misleading. RAM estimates represent a potentially more valid method of trauma center profiling.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed1991    
    Printed101    
    Emailed0    
    PDF Downloaded18    
    Comments [Add]    
    Cited by others 1    

Recommend this journal