INTRODUCTION: Quality indicators are widely needed for external assessment and comparison of trauma care. It is common to extend the use of the American College of Surgeons Committee on Trauma (ACSCOT) audit filters to this scope. This mandates that their actual link with outcome be demonstrated. Several studies attempted to do so, but with inconsistent risk-adjustment, conflicting results and never using long-term disability as outcome measure, despite its recognised importance. We tried to overcome these limitations. METHODS: Risk-adjusted analysis of the association of filters 1, 3, 10 and 13 with 30-day mortality and 6-month disability measured with the EQ5D scale. Multivariate logistic and linear regression models were used respectively. The data came from a National Italian Trauma Registry comprising 838 patients with major trauma. RESULTS: Three (1, 3 and 10) of the filters analysed did not show any significant association with either outcome. Filter 13 was associated with decreased mortality and lower (worse) disability scores. CONCLUSIONS: Methodological difficulties, incomplete, obsolete or non-generalizable definitions of some filters can explain the generally poor correlation with outcomes. The conflicting association of filter 13 with the two types of outcomes raises some interesting questions about the targeted outcomes in trauma research. It is recommended that further studies develop better quality indicators and test their link with both survival and functional outcome in the same setting where they are applied for assessment and comparison of trauma care.
INTRODUCTION: Quality indicators are widely needed for external assessment and comparison of trauma care. It is common to extend the use of the American College of Surgeons Committee on Trauma (ACSCOT) audit filters to this scope. This mandates that their actual link with outcome be demonstrated. Several studies attempted to do so, but with inconsistent risk-adjustment, conflicting results and never using long-term disability as outcome measure, despite its recognised importance. We tried to overcome these limitations. METHODS: Risk-adjusted analysis of the association of filters 1, 3, 10 and 13 with 30-day mortality and 6-month disability measured with the EQ5D scale. Multivariate logistic and linear regression models were used respectively. The data came from a National Italian Trauma Registry comprising 838 patients with major trauma. RESULTS: Three (1, 3 and 10) of the filters analysed did not show any significant association with either outcome. Filter 13 was associated with decreased mortality and lower (worse) disability scores. CONCLUSIONS: Methodological difficulties, incomplete, obsolete or non-generalizable definitions of some filters can explain the generally poor correlation with outcomes. The conflicting association of filter 13 with the two types of outcomes raises some interesting questions about the targeted outcomes in trauma research. It is recommended that further studies develop better quality indicators and test their link with both survival and functional outcome in the same setting where they are applied for assessment and comparison of trauma care.
Authors: Elisabeth Maria Hoogervorst; Eduard Ferdinand van Beeck; Johan Carel Goslings; Pieter Dirk Bezemer; Joost Jan Laurens Marie Bierens Journal: BMC Health Serv Res Date: 2013-03-03 Impact factor: 2.655
Authors: Arturo Chieregato; Annalisa Volpi; Giovanni Gordini; Chiara Ventura; Marco Barozzi; Maria Luisa Rita Caspani; Andrea Fabbri; Anna Maria Ferrari; Enrico Ferri; Aimone Giugni; Massimiliano Marino; Costanza Martino; Mario Pizzamiglio; Maurizio Ravaldini; Emanuele Russo; Laura Trabucco; Susanna Trombetti; Rossana De Palma Journal: BMJ Open Date: 2017-09-29 Impact factor: 2.692