Quantifying the Quality of Extra- and Intramural Trauma Care on an Individual Basis

Abstract

Background: The objective of this study was to identify the variables needed for an alternative method by which the quality of care for trauma patients can be quantified.

Patients and Methods: A prospective analysis of the clinical parameters and interventions was performed for the extramural as well as the intramural scene. Based on the information available after completion of the primary survey, the interventions needed were identified by a multidisciplinary forum made up of internal and external observers. These interventions were compared with the treatment, which was actuallc performed. We evaluated the reproducibility of the decisions made by the forum by means of a variability analysis.

Results: During the review period, 275 patients were evaluated. An Injury Severity Score (ISS) ≥ 18 was recorded in 41 cases. 69 ABC stabilizing interventions were identified by the forum of the injury scene, 32 of which were not performed by the personnel of the emergency medical service (EMS). 91 in-hospital ABC stabilizing interventions were indicated, 22 of which were not performed by the emergency room (ER) personnel. Twelve patients succumbed within the 1st month.

Conclusions: The pilot study confirms the feasibility of using a forum to identify the interventions prescribed by protocol for each individual patient. Forum-based case-to-case evaluation will be used as a surveillance tool to evaluate the adequacy of interventions and to quantify the quality of trauma care.