Complication rates as a trauma care performance indicator: a systematic review

Area of Science:

• Trauma Surgery
• Quality Improvement
• Health Services Research

Background:

• Complication rates are vital for trauma quality improvement.
• Identifying clinically relevant complications for hospital performance evaluation is unclear.
• This study aimed to determine consensus on complications for assessing acute care trauma hospital performance.

Purpose of the Study:

• To evaluate consensus on complications for acute care trauma hospital performance metrics.
• To identify specific nonfatal outcomes used in trauma care quality assessment.

Main Methods:

• Systematic literature search across multiple databases (Medline, EMBASE, etc.).
• Inclusion of studies evaluating trauma hospital performance using nonfatal outcomes.
• Consensus defined as complication use in ≥70% (strong) or ≥50% (weak) of studies.

Main Results:

• 22 studies were included from 14,521 citations, showing significant heterogeneity in complication reporting.
• 79 complications were identified; only pulmonary embolism, deep vein thrombosis, and pneumonia met the weak consensus threshold (≥50%).
• Few studies offered clinical relevance evidence or high methodological quality (5/22).

Conclusions:

• A weak recommendation is made for using pulmonary embolism, deep vein thrombosis, and pneumonia in trauma hospital evaluation.
• Significant disparities in definitions, lack of clinical justification, and low study quality necessitate further research.
• Development of valid, reliable performance indicators is crucial for improving trauma care quality and efficiency.