Complication rates as a trauma care performance indicator: a systematic review
1 Department of Social and Preventive Medicine, Université Laval, 2325 rue de l'Université, Québec City, Québec, Canada G1V 0A6
2 Department of Critical Care Medicine, Medicine and Community Health Sciences (HTS), Institute for Public Health, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, Canada T2N 1N4
3 Axe traumatologie-urgence-soins intensifs, Centre de Recherche FRQ-S du CHA-Hôpital Enfant-Jésus, 1401 18e rue, Quebec City, Québec, Canada G1J 1Z4
4 Department of Anesthesiology, Division of Critical Care Medicine, Université Laval, 2325 rue de l'Université, Québec City, Québec, Canada G1V 0A6
Critical Care 2012, 16:R195 doi:10.1186/cc11680Published: 16 October 2012
Information on complication rates is essential to trauma quality improvement efforts. However, it is unclear which complications are the most clinically relevant. The objective of this study was to evaluate whether there is consensus on the complications that should be used to evaluate the performance of acute care trauma hospitals.
We searched the Medline, EMBASE, Cochrane Central, CINAHL, BIOSIS, TRIP and ProQuest databases and included studies using at least one nonfatal outcome to evaluate the performance of acute care trauma hospitals. Data were extracted in duplicate using a piloted electronic data abstraction form. Consensus was considered to be reached if a specific complication was used in ≥ 70% of studies (strong recommendation) or in ≥ 50% of studies (weak recommendation).
Of 14,521 citations identified, 22 were eligible for inclusion. We observed important heterogeneity in the complications used to evaluate trauma care. Seventy-nine specific complications were identified but none were used in ≥ 70% of studies and only three (pulmonary embolism, deep vein thrombosis, and pneumonia) were used in ≥ 50% of studies. Only one study provided evidence for the clinical relevance of complications used and only five studies (23%) were considered of high methodological quality.
Based on the results of this review, we can make a weak recommendation on three complications that should be used to evaluate acute care trauma hospitals; pulmonary embolism, deep vein thrombosis, and pneumonia. However, considering the observed disparity in definitions, the lack of clinical justification for the complications used, and the low methodological quality of studies, further research is needed to develop a valid and reliable performance indicator based on complications that can be used to improve the quality and efficiency of trauma care.