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Validation of Quality Indicators for Pediatric Trauma Care
Lynne Moore1,2, Natalie L Yanchar3, Suzanne Beno4
1Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, QC, Canada.
Insights
This study developed and validated pediatric trauma quality indicators (QIs) using trauma registry data. Six QIs demonstrated moderate-to-high validity, supporting their use in performance improvement for pediatric trauma care.
Area of Science:
- Pediatric Trauma Care
- Quality Improvement Science
- Health Informatics
Background:
- A recent set of 23 pediatric trauma quality indicators (QIs) requires validity assessment before implementation.
- These QIs are designed for both specialized pediatric and general trauma centers.
Purpose of the Study:
- To develop metrics for pediatric-specific quality indicators (QIs) for trauma care.
- To evaluate the validity of these QIs using established criteria.
Main Methods:
- Data extracted from a Canadian provincial trauma system (April 2016-March 2022).
- Sample included 10,711 pediatric trauma admissions.
- Quality indicators evaluated against Agency for Healthcare Research and Quality criteria.
Main Results:
- Metrics developed for 15 pediatric trauma QIs.
- Six QIs showed moderate-to-high validity across all criteria.
- Examples include timely head CT, vital sign documentation, fracture stabilization, and nutritional support.
Conclusions:
- Operationalizing pediatric trauma QIs using trauma registry data is feasible.
- Coding definitions are provided to facilitate QI implementation.
- Validity evidence guides the selection of QIs for performance improvement programs.
Objective:
To develop metrics for pediatric-specific quality indicators (QIs) for trauma care using trauma registry data and evaluate their validity.
Background:
A set of 23 QIs specific to pediatric trauma care and applicable to both pediatric and non-pediatric trauma centers (PTCs) was recently developed. Their validity needs to be assessed before implementation.
Methods:
We extracted data on children admitted to any trauma center in a Canadian provincial trauma system between April 2016 and March 2022. We evaluated QIs using Agency for Healthcare Research and Quality criteria.
Results:
The study sample comprised 10,711 pediatric trauma admissions. We developed metrics for 15 QIs. Six had moderate-to-high validity on all evaluable criteria: head computed tomography <60 minutes for children with Glasgow Coma Scale <13, documentation of a full set of vital signs in the emergency department, initial head computed tomography in patients at low-risk on a clinical decision rule, stabilization of femoral shaft fractures <24 hours, intracranial pressure monitoring in severe traumatic brain injury, and nutritional support <48 hours of intensive care unit admission. Four had moderate-to-high validity on all but one criterion: PTC transfer for neurotrauma and major multisystem trauma, PTC transfer for major orthopedic trauma, and antibiotics <60 minutes in open long bone fractures.
Conclusions:
This study shows the feasibility of operationalizing QIs for pediatric trauma using trauma registry data, and we provide coding definitions to do so. Results provide evidence on validity that may be used to guide the selection of QIs for performance improvement programs.
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