RT Journal
A1 Glance LG, Dick AW, Mukamel DB, Osler TM
T1 ASsociation between trauma quality indicators and outcomes for injured patients
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD April 1
VO 147
IS 4
SP 308
OP 315
DO 10.1001/archsurg.2011.1327
UL http://dx.doi.org/10.1001/archsurg.2011.1327
AB 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.