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Incidence of opportunities for improvement in trauma patient care: a retrospective registry-based study
Kelvin Szolnoky1, Elias Joneborg2, Jonatan Attergrim2,3
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Introduction:
Trauma is a leading cause of death in individuals aged 45 and younger, contributing significantly to the global disease burden. Local trauma quality improvement programs have been implemented to improve clinical practice and patient outcomes. Multidisciplinary peer reviews, included in quality improvement programs, aim to identify opportunities for improvement in trauma patient care and implement corrective measures. This study assesses the incidence and trends of these opportunities across clinically important trauma cohorts.
Methods:
We conducted a retrospective cohort study using data from the trauma registry at Karolinska University Hospital in Solna, Sweden, between 2017 and 2022. Patients screened for opportunities for improvement were categorized into common trauma cohorts. Logistic regression was used to analyze trends in the occurrence of opportunities for improvement over the years in each cohort. The relationship between opportunities for improvement and trauma cohorts was also assessed.
Results:
Out of 7192 patients included, 404 (6%) had at least one opportunity for improvement. A statistically significant decrease in opportunities for improvement per year was observed overall (OR 0.90; 95% CI 0.84 to 0.95). Significant decreases were identified in patients with blunt multisystem trauma without traumatic brain injury (TBI) (OR 0.82; 95% CI 0.72 to 0.93), isolated severe TBI (OR 0.61; 95% CI 0.41 to 0.91), and severe penetrating injuries (OR 0.68; 95% CI 0.50 to 0.92). The blunt multisystem with TBI cohort showed a non-significant increase. After adjusting for Injury Severity Score, only the blunt multisystem without TBI cohort remained significantly associated with opportunities for improvement (OR 1.69; 95% CI 1.24 to 2.31).
Conclusion:
The incidence of opportunities for improvement in trauma care showed a significant decrease, indicating that the current trauma quality improvement program at Karolinska University Hospital may be effective in reducing opportunities for improvement. Patients with blunt multisystem trauma without TBI were at higher risk for opportunities for improvement compared with other trauma cohorts.
Level Of Evidence:
Level IV: retrospective study with up to three negative criteria.
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