Trauma Quality Indicators’ usage limitations in severe trauma patients

Abstract

Purpose: to analyze the relation between Trauma Quality Indicators (QI) and death, as well as clinical adverse events in severe trauma patients. Methods: analysis of data collected in the Trauma Register between 2014-2015, including patients with Injury Severity Score (ISS) > 16, reviewing the QI: (F1) Acute subdural hematoma drainage > 4 hours with Glasgow Coma Scale (GCS) <9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours; (F4) Admission-laparotomy time greater than 60 min in hemodynamically instable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time > 6 hours; (F10) Surgery > 24 hours. T the chi-squared and Fisher tests were used to calculate statistical relevance, considering p<0.05 as relevant. Results: 127 patients were included, whose ISS ranged from 17 to 75 (28.8 + 11.5). There were adverse events in 80 cases (63%) and 29 died (22.8%). Twenty-six patients had some QI compromised (20.6%). From the 101 patients with no QI, 22% died, and 7 of 26 patients with compromised QI (26.9%) (p=0.595). From the patients with no compromised QI, 62% presented some adverse event. From the patients with any compromised QI, 18 (65.4%) had some adverse event on clinical evolution (p=0.751). Conclusion: the QI should not be used as death or adverse events predictors in severe trauma patients.

Trauma Registry: Trauma Quality indicators analysis in hospitalized patients

“…The use of Quality Filters as points of care in the trauma patient care chain had already been consolidated in previous research 19,27,35,37,43,44 with smaller populations.…”

“…The use of Quality Filters as points of care in the trauma patient care chain had already been consolidated in previous research 19 , 27 , 35 , 37 , 43 , 44 with smaller populations. However, its validation in the selected sample, through representativeness and segmental analysis, endorses the use of these parameters as a mechanism for detecting service failures in trauma victims in the Brazilian reality.…”

Registro de Trauma: análise dos Filtros de Qualidade nos pacientes internados

“…Os "filtros de auditoria" ou Filtros de Qualidade (FQ) são variáveis propostas pelos assistentes de cada serviço a serem monitoradas e que, quando presentes, podem representar oportunidades de melhora para o sistema [20][21][22][23][24][25] Além dos dados clínicos-demográficos, foi realizada a coleta de informações dirigida para avaliação de qualidade de atendimento, através de Filtros de Qualidade/ Auditoria, conforme aqueles já estabelecidos em nosso serviço 35,36 , baseados naqueles propostos inicialmente pelo American College of Surgeons em 199026 adaptando-nos o à realidade de nosso serviço e editando-os (Tabela 1). Houve 17 fraturas de ossos do crânio (3,65%), 21 fraturas de face (4,7%), 9 Hematomas Epidurais (2%), 8 Hematomas Subdurais (1,8%) e 12 contusões cerebrais (2,7%); 42 fraturas de membros superiores (9,1%), 50 de membros inferiores (10,8%) -com apenas 1 lesão vascular periférica -15 de pelve (3,2%) e 18 de coluna (3,9%).…”

“…A utilização dos Filtros de Qualidade como pontos de atenção na cadeia de atendimento ao paciente traumatizado ja fora consolidado em pesquisas previas 19,27,35,37,43,44…”