Indicators of the quality of trauma care and the performance of trauma systems

Br J Surg. 2012 Jan;99 Suppl 1:97-104. doi: 10.1002/bjs.7754.


Background: Valid and reliable measures of trauma system performance are needed to guide improvement activities, benchmarking and public reporting, future investment and research. Traditional measures of in-hospital mortality fail to take into account prehospital and posthospital care, recovery after discharge, and the nature and costs of long-term disability.

Methods: Drawing on recent systematic reviews, an overview was conducted of existing and emerging trauma care performance indicators. Changes in the nature and purpose of indicators were assessed.

Results: Among a large number of existing, mostly locally developed performance indicators, only peer review of deaths has evidence of validity or reliability. The usefulness of the traditional performance measure of in-hospital mortality has been challenged. There is an emerging shift in focus from mortality to non-mortality outcomes, from hospital-based to long-term community-based outcome assessment, and from single measures of trauma centre performance to measures better suited to monitoring the performance of systems of care spanning the entire patient journey. As a result, a new generation of indicators is emerging that are both feasible and potentially more useful for commissioners and payers of population-based services.

Conclusion: A global endeavour is now under way to agree on a set of standardized performance indicators that are meaningful to patients, carers, clinicians, managers and service funders, are likely to contribute to desired outcomes, and are valid, reliable and have a strong evidence base.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Benchmarking / standards
  • Delivery of Health Care / standards*
  • Emergency Medical Services / standards
  • Hospital Mortality
  • Humans
  • Quality Improvement
  • Quality Indicators, Health Care*
  • Quality of Life
  • Traumatology / standards*
  • Treatment Outcome
  • Wounds and Injuries / mortality
  • Wounds and Injuries / therapy*