The inclination toward rank ordering items into lists dates back to Dick Clark’s American Bandstand show of the late 1950s, which he ended with the top 10 records of the week. Over the ensuing years, several publications, including People magazine, Cosmopolitan, the New Yorker, and the Wall Street Journal, adopted this listing technique. Today one can search for “top 10 list” on the Internet and find close to 1.6 billion hits. The top hit will likely be related to Late Night with David Letterman (now the Late Show with David Letterman), which popularized these lists and made them part of pop culture since airing a segment called “The Top Ten Things That Almost Rhyme With Peas” 30 years ago. Along with the Late Show’s iconic “Top 10 List” one can find the top 10 most venomous snakes, the top 10 sources of renewable energy, and so on.
Top 10 complications
Since 2011, the top 10 list of complications has been a part of the National Trauma Data Bank® Annual Report. A medical complication is defined as “a secondary disease or condition that develops in the course of a primary disease or condition and arises either as a result of it or from independent causes.”* On occasion, in spite of a medical team’s best efforts, complications may occur. Complications can contribute to morbidity, mortality, an increased length of stay, and delays in recovery from traumatic injuries. According to the National Trauma Data Standard 2013 Admissions Data Dictionary, 22 complications are listed as possible choices to be entered into the field for hospital complications.
The National Trauma Data Bank (NTDB®) Annual Report 2013 includes a table listing the 22 complications with their frequencies (see Table) and a graph (see Figure) that displays the top 10 complications reported in 2013 admission year medical records. These cases accounted for 74,265 (83 percent) of the total of 89,971 reported complications. In fact, the top two complications, pneumonia (17,094) and urinary tract infection (12,484), comprise one-third of all of the complications listed.
Government payors for the past several years have been taking a hard look at complications and the resultant increase in health care costs. Public databases are tracking hospital-specific rates on complications, mortality rates, and safety profiles. The health care payment paradigm continues to shift and with it, care for certain complications will no longer be reimbursed. Landing on the top 10 list is often a prestigious honor, but not when it comes to complications.
Throughout the year, we will be highlighting data through brief reports in the Bulletin. The National Trauma Data Bank Annual Report 2013 is available on the ACS website as a PDF file at www.ntdb.org. In addition, information about how to obtain NTDB data for more detailed study is available on the website. To learn more about submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at firstname.lastname@example.org.
* Merriam-Webster.com. “Complication.” Available at: http://www.merriam-webster.com/medical/complication. Accessed January 27, 2014.