Association between trauma quality indicators and outcomes for injured patients

Abstract

Objective: To examine the association between the American College of Surgeons Committee on Trauma (ACSCOT) quality indicators and outcomes.

Design: Cross-sectional study.

Setting: Data from the Pennsylvania Trauma Outcome Study.

Patients: We studied data from 210,942 patients admitted to 35 trauma centers in Pennsylvania between 2000 and 2009.

Main outcome measures: Regression analyses were performed to examine the association between ACSCOT quality indicators and in-hospital mortality and death or major complications.

Results: Seven of the ACSCOT quality indicators were associated with either increased (1) in-hospital mortality or (2) death or major complications. No head computed tomography scan in patients with a Glasgow Coma Scale score less than 13 was associated with a 4-fold increase in mortality (adjusted odds ratio [AOR], 4.39; 95% confidence interval [CI], 3.18-6.07) and a nearly 3-fold increased risk of death or major complications (AOR, 2.76; 95% CI 2.05-3.72). Gunshot wounds to the abdomen managed nonoperatively were associated with a nearly 5-fold increase in mortality (AOR, 4.80; 95% CI, 2.95-7.81). Femoral fractures treated with nonfixation were also strongly associated with mortality (AOR, 4.08; 95% CI, 2.50-6.66) and death or major complications (AOR, 2.54; 95% CI, 1.96-3.31).

Conclusion: Several current ACSCOT quality indicators have a strong association with clinical outcomes. These findings should be interpreted with caution because some measures may lack face validity for identifying poor-quality care in complex patients with multiple injuries.