Assessing quality of care in a trauma referral center: benchmarking performance by TRISS-based statistics or by analysis of stratified ISS data?

The Journal of Trauma
Nils O SkagaPetter A Steen

Abstract

Using prospectively collected data from Ulleval University Hospital in Norway, standard TRISS-based methods with case mix correction were compared with analysis based on ISS stratified data. Reference data were The Major Trauma Outcome Study (MTOS) controlled sites, used for calculation of AIS 90 based TRISS coefficients. Present TRISS convention requires RTS scoring on hospital admission, excluding many severely injured patients intubated before arrival. Therefore, all Ulleval patients were RTS scored using prehospital data if needed. There was 6.6% of MTOS controlled sites patients (mortality rate 26.7%) that had been excluded before estimation of TRISS coefficients because of lack of data for Ps calculation. Analyses based on ISS stratified data included these patients and indicated significant better performance at Ulleval for blunt, but not for penetrating trauma. No TRISS-based analysis detected this difference. The RTS convention should be changed to reduce patient exclusion. Presently, stratified ISS based data should also be analyzed.

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Citations

Sep 13, 2007·Irish Journal of Medical Science·M C FitzgibbonD J Bouchier-Hayes
Nov 18, 2009·The Journal of Trauma·Andreas Saxlund PahleJohan Pillgram-Larsen
Jun 18, 2011·Journal of Trauma Management & Outcomes·Thomas KristiansenPål A Næss
Oct 30, 2008·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Kjetil G RingdalUNKNOWN Utstein TCD expert panel
Jan 13, 2009·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Marius RehnHans Morten Lossius
Jan 28, 2012·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Thomas KristiansenHans M Lossius
Sep 28, 2007·World Journal of Surgery·Kjetil SøreideHans Morten Lossius
Aug 21, 2009·World Journal of Surgery·Ida Füglistaler-MontaliThomas Gross
Dec 1, 2008·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Lauri HandolinEero Hirvensalo
Oct 1, 2009·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Tim SöderlundLauri Handolin
Apr 1, 2012·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·H TuovinenL Handolin
Aug 23, 2007·Acta Anaesthesiologica Scandinavica·S H KannE F Christensen
Aug 24, 2007·Acta Anaesthesiologica Scandinavica·O UlebergE Skogvoll
Jan 15, 2015·Acta Anaesthesiologica Scandinavica·T DehliT Wisborg
Sep 2, 2010·The Journal of Trauma·Pål A RønningKnut Stavem

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