2022 ESO Trauma Index: Benchmarks and Focus Questions

Posted on November 28, 2022
Tags: EMS, Hospital

Last week, we launched the 2022 ESO Trauma Index – the annual research to facilitate industry conversations, set benchmarks, and compare hospital and trauma systems’ performance with peers. Created from the world’s largest de-identified trauma registry data program, the second installation of this index looked at more than 884,456 patient records from January 1, 2021 through December 31, 2021. Below, we highlight this year’s focus questions and a few sneak peeks at our 2022 observation.

To get the full report, download the full ESO Trauma Index now. >>  

2022 Focus Questions

For each Index, our researchers select key metrics relevant to the industry today. The main topics for this Trauma Index include whole blood usage, time to antibiotics in open long bone fracture (and how it differed based on age), time to surgical repair for geriatric patients with hip fracture, frequency of specific hospital events, and the injury severity score (ISS) breakdown for this set of agencies. The ESO Trauma Index includes recommended response actions for each area and encourages systems to continue observing and comparing their own real-world data.

Whole Blood

Focus Question: What percentage of trauma patients (who met the Early Blood Transfusion Needs Score) received whole blood? 

Uncontrolled hemorrhages are the most common cause of death within the first hour of a patient’s arrival at a trauma center. Recent studies suggest increased benefits of using whole blood for transfusions compared with component blood products for trauma patients who are in hemorrhagic shock. But how many trauma systems are actually using whole blood? And for those still using component blood products, how quickly are they being administered?

  • A sneak peek at our observation: Our study showed nearly 4% of patients meeting the EBTNS definition for blood transfusion received whole blood. This suggests that while prehospital and ED providers are beginning to see the value in administering whole blood, by and large, the use of whole blood by trauma centers is sparse.



Focus Question: How long does it take patients with open long bone fractures to receive antibiotics? What is the time to surgical repair for a geriatric patient with a hip fracture?

In this Index, we explore two fracture-related metrics regarding antibiotic usage and geriatric hip fractures. Early administration of antibiotics (within the first 60 minutes of arrival in the ED) has been associated with a significantly lower risk of infection. We looked at how often antibiotics were being administered, and how the administration varied by age group. Additionally, faster surgical intervention for the geriatric age group decreases morbidity and mortality, so we explored how quickly geriatric patients were transferred to the OR.

  • A sneak peek of our key observation: Of the patients suffering from an open long bone fracture, 61% received antibiotics within 60 minutes upon arrival at the emergency department. However, children and geriatric patients received prompt antibiotics at a lower frequency than adults aged 18-64, suggesting more attention may be needed when caring for these populations.


Hospital Events

Focus Question: How often do key hospital events (such as deep vein thrombosis or severe sepsis) occur?

Unfortunately, complications or sentinel events are a reality for trauma systems, resulting in preventable injury or death for patients, as well as millions of dollars in expenses for hospitals. We explored which hospital events are the most common, helping hospitals identify increased risk factors to create more accurate benchmarking and processes.

  • A sneak peek of our key observation: Nearly 8% of patients recorded had at least one hospital event. The most common events were unplanned admission to ICU, delirium, unplanned intubation, cardiac arrest with CPR, and unplanned visit to the OR. By recognizing these highly likely events, hospitals can increase safety measures and improve QA processes.


Injury Severity Score

Focus Question: What is the injury severity score (ISS) breakdown?

Susan P. Baker, MPH is widely known for developing the ISS, which standardizes the severity of injuries. The higher the number, the more severe the injury. We examined the score and transport frequencies, and survival and mortality rates compared to levels of severity.

  • A sneak peek at our key observation: More than 50% of all patients with trauma-related injuries received treatment at a Level I trauma center, and these patients had a greater than 95% survival rate. As expected, patients with the most severe injuries and highest ISS scores (greater than or equal to 25) experienced the highest mortality rates at more than 30%.

We hope this Index–in partnership with other industry research–paints an accurate picture of what is taking place within a trauma system. With this knowledge, administrators and providers can make data-driven decisions, prepare for the unexpected, and improve patient care while driving down costs. Real-world data viewed through the lens of industry-wide trends help ensure the quality of care continues to increase through smart decisions and evidence-based processes.

The Trauma Index is a complement to ESO’s annual Fire and EMS Indices, available throughout the year. To hear the ESO research team discuss this research in person, join us at Wave 2023 on April 11-14.