The Pennsylvania trauma outcomes study risk-adjusted mortality model: Results of a statewide benchmarking program

Douglas J. Wiebe, Daniel N. Holena, Kit Delgado, Nathan McWilliams, Juliet Altenburg, Brendan G. Carr

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n 5 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve 5 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance.

Original languageEnglish
Pages (from-to)445-452
Number of pages8
JournalAmerican Surgeon
Issue number5
StatePublished - May 2017
Externally publishedYes


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