Risk Factors Associated with Death in the Emergency Department in Indiana, 2013-2014

BACKGROUND:   The trauma system in Indiana is developing. The Trauma Registry rule, requiring all hospitals with Emergency Departments (ED) to report trauma cases to the Indiana State Department of Health Patient Registry, became effective November 24, 2013. As Indiana builds its trauma system reviewing patient outcomes has been instrumental in improving patient care. 

METHODS:   Data for all trauma cases in Indiana EDs from January 1, 2013 through June 30, 2014were obtained from the Indiana Patient Registry. Logistic regression modeling was performed with ED disposition as the outcome variable (dichotomized as expired/did not expire) and age, race, gender, alcohol use, trauma type and trauma center status as the independent variables. Alcohol use, trauma type and trauma center status are the variables of interest.

RESULTS:   There were 42,745 trauma incidents with available ED disposition data; 333 of these resulted in death. Gender, trauma type and alcohol were statistically significant and age approached statistical significance. Trauma incidents that experienced ‘Other trauma type’ have 1.6 times the odds of expiring in the ED compared to ‘Blunt trauma type.’  Trauma incidents with ‘Penetrating trauma type’ have 6.73 times the odds of expiring in the ED compared to ‘Blunt trauma type’.  Trauma incidents where alcohol consumption was ‘Not Known/Nor Recorded/Not Applicable’ had 0.99 times the odds of expiring in the ED compared to those with no alcohol consumption. Trauma incidents where alcohol was consumed had 0.46 the odds of expiring in the ED compared to those with no alcohol consumption. 

CONCLUSIONS:   Emergency department disposition was not completed on all trauma forms. There could be other factors in pre-hospital care that influence ED disposition, such as level of EMT and procedures performed that are not included in this study. Patients that experienced penetrating trauma were 6.73 times more likely to die than those that had blunt trauma. Alcohol was a protective factor against death in the ED. Further research with larger sample sizes could identify risk factors related to ED outcomes other than the dichotomous expired versus not expired.