J Tiao1,2, L Moore1,2, T V Porgo3,4, A Belcaid2. 1. Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada. 2. Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada. 3. Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada. tvporgo@gmail.com. 4. Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada. tvporgo@gmail.com.
Abstract
PURPOSE: To assess whether the definition of an IHF used as an exclusion criterion influences the results of trauma center benchmarking. METHODS: We conducted a multicenter retrospective cohort study with data from an integrated Canadian trauma system. The study population included all patients admitted between 1999 and 2010 to any of the 57 adult trauma centers. Seven definitions of IHF based on diagnostic codes, age, mechanism of injury, and secondary injuries, identified in a systematic review, were used. Trauma centers were benchmarked using risk-adjusted mortality estimates generated using the Trauma Risk Adjustment Model. The agreement between benchmarking results generated under different IHF definitions was evaluated with correlation coefficients on adjusted mortality estimates. Correlation coefficients >0.95 were considered to convey acceptable agreement. RESULTS: The study population consisted of 172,872 patients before exclusion of IHF and between 128,094 and 139,588 patients after exclusion. Correlation coefficients between risk-adjusted mortality estimates generated in populations including and excluding IHF varied between 0.86 and 0.90. Correlation coefficients of estimates generated under different definitions of IHF varied between 0.97 and 0.99, even when analyses were restricted to patients aged ≥65 years. CONCLUSIONS: Although the exclusion of patients with IHF has an influence on the results of trauma center benchmarking based on mortality, the definition of IHF in terms of diagnostic codes, age, mechanism of injury and secondary injury has no significant impact on benchmarking results. Results suggest that there is no need to obtain formal consensus on the definition of IHF for benchmarking activities.
PURPOSE: To assess whether the definition of an IHF used as an exclusion criterion influences the results of trauma center benchmarking. METHODS: We conducted a multicenter retrospective cohort study with data from an integrated Canadian trauma system. The study population included all patients admitted between 1999 and 2010 to any of the 57 adult trauma centers. Seven definitions of IHF based on diagnostic codes, age, mechanism of injury, and secondary injuries, identified in a systematic review, were used. Trauma centers were benchmarked using risk-adjusted mortality estimates generated using the Trauma Risk Adjustment Model. The agreement between benchmarking results generated under different IHF definitions was evaluated with correlation coefficients on adjusted mortality estimates. Correlation coefficients >0.95 were considered to convey acceptable agreement. RESULTS: The study population consisted of 172,872 patients before exclusion of IHF and between 128,094 and 139,588 patients after exclusion. Correlation coefficients between risk-adjusted mortality estimates generated in populations including and excluding IHF varied between 0.86 and 0.90. Correlation coefficients of estimates generated under different definitions of IHF varied between 0.97 and 0.99, even when analyses were restricted to patients aged ≥65 years. CONCLUSIONS: Although the exclusion of patients with IHF has an influence on the results of trauma center benchmarking based on mortality, the definition of IHF in terms of diagnostic codes, age, mechanism of injury and secondary injury has no significant impact on benchmarking results. Results suggest that there is no need to obtain formal consensus on the definition of IHF for benchmarking activities.
Entities:
Keywords:
Definition; Exclusion criterion; Isolated hip fractures; Trauma system benchmarking
Authors: David Gomez; Barbara Haas; Mark Hemmila; Michael Pasquale; Sandra Goble; Melanie Neal; N Clay Mann; Wayne Meredith; Henry G Cryer; Shahid Shafi; Avery B Nathens Journal: J Trauma Date: 2010-11