RT Journal Article
SR Electronic
T1 Excess Mortality Caused by Medical Injury
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 410
OP 416
DO 10.1370/afm.553
VO 4
IS 5
A1 Linda N. Meurer
A1 Hongyan Yang
A1 Clare E. Guse
A1 Carla Russo
A1 Karen J. Brasel
A1 Peter M. Layde
YR 2006
UL http://www.annfammed.org/content/4/5/410.abstract
AB PURPOSE We wanted to estimate excess risk of in-hospital mortality associated with medical injuries identified using an injury surveillance system, after controlling for risk of death resulting from comorbidities. METHODS The Wisconsin Medical Injuries Prevention Program (WMIPP) screening criteria were used to identify medical injuries, defined as “any untoward harm associated with a therapeutic or diagnostic healthcare intervention,” among discharge diagnoses for all 562,317 patients discharged from 134 acute care hospitals in Wisconsin in 2002. We then derived estimates for crude and adjusted relative risk of in-hospital mortality associated with the presence of a medical injury diagnosis. Logistic regression adjusted for baseline risk of mortality using a comorbidity index, age, sex, Diagnosis Related Groups, hospital characteristics, and clustering within hospital. RESULTS There were 77,666 discharges that met WMIPP criteria for at least 1 medical injury (13.8%). Crude risk ratios for death ranged from 1.27 to 2.4 for those with medical injuries within 1 of 4 categories: drugs/biologics; devices, implants, and grafts; procedures; and radiation. After adjustment, estimates of excess mortality decreased, and significance persisted only for injuries related to procedures (39%; 95% confidence interval [CI], 28%–52%) and devices, implants, and grafts (16%; 95% CI, 3%–30%). CONCLUSIONS Estimates of excess mortality that do not account for baseline mortality risk may be exaggerated. Findings have implications for the care family physicians provide in the hospital and for the advice they give their patients who are concerned about the risks of hospitalization.