A systematic review of quality indicators for evaluating pediatric trauma care

Objective: Trauma care provides injured children with life-and limb-saving treatment, but it is unclear if the proper tools have been developed to measure the quality of care delivered. We sought to systematically review the literature on quality indicators for evaluating pediatric trauma care. Data Sources and Study Selection: We searched MEDLINE (1950-January 14, 2009), EMBASE (1980-week 2, 2009), CINAHL (1982-week 2, 2009) and The Cochrane Library (4th Quarter 2008) from the earliest available date to January 14, 2009, plus the Gray Literature, select journals by hand, reference lists, and articles recommended by experts in the field. Studies were selected that used one or more quality indicators to evaluate the quality of care delivered to patients 18 yrs of age or younger with a major traumatic injury. Data Extraction and Data Synthesis: The literature search identified 6869 citations. Review of abstracts led to the retrieval of 538 full-text articles for assessment; 12 articles were selected for review. Of these, five (42%) articles were case series and five (42%) articles were cohort studies. Two articles included control groups, a before-and-after case series, and a nonrandomized controlled trial. A total of 120 quality indicators in pediatric trauma care were identified, predominantly measures of prehospital and hospital processes and outcomes of care. We did not identify any prehospital structure or posthospital or secondary injury prevention quality indicators. Among multiple trauma patients, deficiencies in the quality of care ranged from 8% to 45% of patients, with 6% to 32% of deaths in hospital judged to be preventable on peer review. Conclusions: There is limited experimental research regarding quality indicators in pediatric trauma care, but the literature suggests that deficiencies exist in the quality of care. Future research is needed to develop and evaluate patient-centered pediatric-specific indicators that cover the full spectrum of trauma care. (Crit Care Med 2010; 38: 1187-1196)