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Trauma center performance indicators for nonfatal outcomes: A scoping review of the literature

Moore, Lynne PhD; Stelfox, Henry Thomas MD, PhD; Boutin, Amélie MSc; Turgeon, Alexis F. MD, MSc

Journal of Trauma and Acute Care Surgery: May 2013 - Volume 74 - Issue 5 - p 1331–1343
Original Articles

BACKGROUND: According to Donabedian's framework, outcomes covering the following six domains should be used to evaluate health care quality: death, adverse events, readmissions to hospital, resource use, quality of life, and ability to function in daily activities. The objective of this study was to identify the nonfatal outcomes that have been used to evaluate the performance of trauma hospitals. Secondary objectives were to describe definitions and methodological quality.

METHODS: We performed a scoping literature review of studies using at least one nonfatal outcome to evaluate the performance of acute care hospitals for the treatment of general trauma populations. We searched MEDLINE, EMBASE, Cochrane central, CINAHL, BIOSIS, TRIP and ProQuest databases. Methodological quality was evaluated using elements of the STROBE statement and the Downs and Black tool.

RESULTS: Of 14,521 citations, 40 were eligible for inclusion. We identified 14 nonfatal outcomes as follows: (i) adverse events including complications (used in 35 evaluations), missed injuries (n = 4), reintubation (n = 2), unplanned intensive care unit admissions (n = 2), and unplanned surgeries (n = 4); (ii) resource use including hospital (n = 19), intensive care unit (n = 15), and ventilator (n = 4) length of stay, inappropriate hospital stay (n = 1), and potentially unnecessary care (n = 1); (iii) hospital readmissions (n = 4); and (iv) ability to function in daily activities including functional capacity (n = 2), and discharge destination (n = 3). No measures of quality of life were identified. There was high heterogeneity in the definitions used. Only 18% of studies had high methodological quality.

CONCLUSION: Among recommended domains of nonfatal outcomes, adverse events and resource use were frequently used to evaluate trauma care, readmissions and function in daily activities were rarely used, and quality of life was never used. In addition, definitions of nonfatal outcomes were variable, and methodological quality was low. There is a need to develop valid and reliable performance indicators based on each domain of Donabedian's framework to evaluate trauma care.

From the Department of Social and Preventative Medicine (L.M.), Université Laval; Unité de traumatologie-urgence-soins intensifs (L.M., A.B., A.F.T.), Centre de Recherche du CHU-pavillon Enfant-Jésus, and Division of Critical Care Medicine (A.F.T.), Department of Anesthesiology, Université Laval, Quebec City, Quebec; Department of Critical Care Medicine (H.T.S.), Medicine and Community Health Sciences, Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.

Submitted: October 24, 2012, Revised: December 12, 2012, Accepted: December 12, 2012.

Address for reprints: Lynne Moore, PhD, Centre de recherche du CHU - Pavillon Enfant-Jésus, 1401, 18e rue, local H-012a, Québec (Québec), G1J 1Z4; email:

© 2013 Lippincott Williams & Wilkins, Inc.