Determining Trauma Quality Indicators in Pediatrics to Improve Outcomes
Women and Children
Quality-of-care models currently being used at pediatric centers have been uniquely designed only for adult trauma populations, making their applicability for pediatric trauma populations questionable. Our results confirmed that the currently used adult indicators do not perform well when applied to our population. The new Pediatric Trauma Quality Indicator (PTQI) model designed within this study increased the accuracy of tracking quality of care.
We believe that this is the first step toward establishing quality indicators specific to pediatric trauma. This project will increase a hospital’s ability to identify unmet quality indicators and make system-level changes to improve patient care and safety. The next step will be to apply these indicators prospectively, and to validate then externally at other pediatric centers.
Background/Purpose: Current quality-of-care models were designed for adult trauma populations, making their applicability for pediatric trauma questionable. We aimed to modify the American College of Surgeons Committee on Trauma (ACSCOT) adult trauma quality indicators (QIs) to establish a set of pediatric trauma QIs.
Methods: We retrospectively reviewed data collected from the Ottawa trauma database, identifying 1440 patients. The main outcome was a composite outcome of death or major complication. We assessed sensitivities and specificities of the 16 ACSCOT indicators and 8 new pediatric QIs. Selecting the highest performing indicators both groups of indicators, a final model of pediatric trauma QIs was created.
Results: The original adult ACSCOT indicators reached a maximum sensitivity of 42.4% and a specificity of 54.4%. The newly developed Pediatric Trauma Quality Indicators (PTQI) model had a sensitivity of 85.7% and a specificity of 39.6%, with 819 false positives and 17 false negatives.
Conclusions: The original adult ACSCOT model was not appropriate for a pediatricsdue to an overall low sensitivity. The newly developed PTQI indicator model showed increased sensitivity and thus is more appropriate for tracking quality of care in this patient population. Further research is needed to validate this model elsewhere andinvestigate other potential QIs.