Evidence for quality indicators to evaluate adult trauma care: A systematic review

Objective: Multiple quality indicators are available to evaluate adult trauma care, but their characteristics and outcomes have not been systematically compared. We sought to systematically review the evidence about the reliability, validity, and implementation of quality indicators for evaluating trauma care. Data Sources: Search of MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 14, 2009; the Gray Literature; select journals by hand; reference lists; and articles recommended by experts in the field. Study Selection: Studies were selected that evaluated the reliability, validity, or the impact of one or more quality indicators on the quality of care delivered to patients >= 18 yrs of age with a major traumatic injury. Data Extraction: Reviewers with methodologic and content expertise conducted data extraction independently. Data Synthesis: The literature search identified 6869 citations. Review of abstracts led to the retrieval of 538 full-text articles for assessment; 40 articles were selected for review. Of these, 20 (50%) articles were cohort studies and 13 (33%) articles were case series. Five articles used control groups, including three before and after case series, a case-control study, and a non-randomized controlled trial. A total of 115 quality indicators in adult trauma care was identified, predominantly measures of hospital processes (62%) and outcomes (17%) of care. We did not identify any posthospital or secondary injury prevention quality indicators. Reliability was described for two quality indicators, content validity for 22 quality indicators, construct validity for eight quality indicators, and criterion validity for 46 quality indicators. A total of 58 quality indicators was implemented and evaluated in three studies. Eight quality indicators had supporting evidence for more than one measurement domain. A single quality indicator, peer review for preventable death, had both reliability and validity evidence. Conclusions: Although many quality indicators are available to measure the quality of trauma care, reliability evidence, validity evidence, and description of outcomes after implementation are limited. (Crit Care Med 2011; 39: 846-859)