Trauma quality indicators: a way to identify attention points in the treatment of elderly trauma patients

Abstract

Purpose: to trauma quality indicators as a tool to identify opportunities of improvement in elderly trauma patient’s’ treatment. Methods: prospective analysis of data collected between 2014-2015, and stored in the iTreg software (by Ecossistemas). Trauma victims, aged older than 60 years and trauma quality indicators were assessed, based on those supported by SBAIT in 2013: (F1) Acute subdural hematoma drainage after 4 hours from admission, in patients with GCS<9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours from extubation; (F4) Admission-laparotomy time greater than 60 min. in hemodynamically uinstable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours from admission; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time greater than 6 hours; (F10) Surgery after 24 from admission. The indicators, treatments, adverse effects and deaths were analyzed, using the SPSS software, and the chi-squared and Fisher tests were used to calculate the statistical relevance. Results: from the 92 cases, 36 (39,1%) had complications and 15 (16,3%) died. The adequate use of quality indicator’s were substantially different among those who survived (was of 12%) compared to those who died (55,6%). The incidence of complications was of 77,8% (7/9) in patients with compromised indicators and 34,9% (28/83) in those without (p=0.017). Conclusions: trauma quality indicators are directly related with the occurrence of complications and deaths, in elderly trauma patients.

Trauma Quality Indicators’ usage limitations in severe trauma patients

“…Our findings are different from those found in previous studies related to the use of QIs in the identification of preventable complications and deaths 8 , 9 , whose results demonstrated improvement in the quality of care and in the outcome when the pre-established indicators were complied with. This difference suggests that pre-hospital care and surgical conduct strategies are the main factors related to mortality of patients with severe injuries 16 , 17 .…”

“…Several models of quality programs to trauma care have been proposed, such as morbidity and mortality meetings, study of avoidable deaths, auditing monitoring of indicators, establishment of morbidity and mortality review committees, cycle closing with the team, and especially trauma records. The use of trauma indices, such as the Glasgow Coma Scale (GCS) 5 , the Abbreviated Injury Scale (AIS) 6 and the Injury Severity Score (ISS) 7 to stratify the severity of the victims, associated with the monitoring of quality/auditing indicators (QIs), proved to be effective in identifying potentially preventable deaths 8 , allowing detailing of improvement points in care 9 .…”

Practice of Multidisciplinary Collaborative Chain Management Model in Constructing Nursing Path for Acute Trauma Treatment

“…Early identification of trauma types and conditions and the formulation of corresponding treatment plans can improve the prognosis of patients and ensure the life and health of patients. Therefore, ensuring efficient first aid and improving the quality of nursing is the focus of clinical attention [ 12 ].…”

“…Efficient emergency treatment is a key factor in ensuring acute trauma patients. Previous studies have shown that every 3-minute delay in the effective treatment of acute trauma patients can increase the risk of death by 1% [ 12 ]. With the prolongation of injury time, a large amount of blood loss and fluid loss in acute trauma patients can not only lead to hypoxia but also increase the risk of ARDS.…”

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%).…”