Current Trauma Reports

, Volume 4, Issue 2, pp 160–169 | Cite as

Quality Benchmarking in Trauma: from the NTDB to TQIP

  • Melissa A. Hornor
  • Christopher Hoeft
  • Avery B. Nathens
Patient Safety and Quality in Trauma (H Kaafarani, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Patient Safety and Quality in Trauma


Purpose of Review

This review describes the evolution of quality improvement in trauma from the creation of the Committee on Trauma’s (COT) Optimal Hospital Resources for Care of the Injured Patient in 1976 to the National Trauma DataBank (NTDB) to the American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP).

Recent Findings

The national standardization of data collection for trauma patients through the National Trauma Data Standard (NTDS) and TQIP has allowed trauma centers to benchmark with their peers and focus quality improvement initiatives on areas of opportunity. TQIP provides enrolled hospitals with the data and educational resources they need to improve trauma care.


This review describes the development of ACS TQIP and quality benchmarking in trauma. The ACS COT began its journey to improve the quality of trauma care by establishing standards for the optimal care of injured patients and verifying that centers had the necessary equipment, personnel, and processes in place. The standardization of data collection for seriously injured patients nationally now has allowed trauma centers to meaningfully measure patient outcomes. ACS TQIP has further advanced trauma care by providing participating centers with the resources they need to achieve quality improvement in trauma.


Injury Trauma Registry Data Benchmarking Quality improvement 


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Optimal hospital resources for care of the seriously injured. Bull Am Coll Surg. 1976;61(9):15–22.Google Scholar
  2. 2.
    Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2003). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Available from: Accessed January, 2018.
  3. 3.
    MacKenzie EJ, Hoyt DB, Sacra JC, Jurkovich GJ, Carlini AR, Teitelbaum SD, et al. National inventory of hospital trauma centers. JAMA. 2003;289(12):1515–22.CrossRefPubMedGoogle Scholar
  4. 4.
    DiRusso S, Holly C, Kamath R, Cuff S, Sullivan T, Scharf H, et al. Preparation and achievement of American College of Surgeons level I trauma verification raises hospital performance and improves patient outcome. J Trauma. 2001;51(2):294–299; discussion 299-300.CrossRefPubMedGoogle Scholar
  5. 5.
    Maggio PM, Brundage SI, Hernandez-Boussard T, Spain DA. Commitment to COT verification improves patient outcomes and financial performance. J Trauma. 2009;67(1):190–194; discussion 194-195.CrossRefPubMedGoogle Scholar
  6. 6.
    MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–78.CrossRefPubMedGoogle Scholar
  7. 7.
    Boyd DR, Lowe RJ, Baker RJ, Nyhus LM. Trauma registry. New computer method for multifactorial evaluation of a major health problem. JAMA. 1973;223(4):422–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Hospital and prehospital resources for optimal care of the injured patient. Committee on Trauma of the American College of Surgeons. Bull Am Coll Surg. 1986;71(10):4–23.Google Scholar
  9. 9.
    Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27(4):370–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Champion HR, Copes WS, Sacco WJ, et al. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 1990;30(11):1356–65.CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen ME, Ko CY, Bilimoria KY, et al. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg. 2013;217(2):336–346.e331.CrossRefPubMedGoogle Scholar
  12. 12.
    Cohen ME, Liu Y, Ko CY, Hall BL. Improved surgical outcomes for ACS NSQIP hospitals over time: evaluation of hospital cohorts with up to 8 years of participation. Ann Surg. 2016;263(2):267–73.CrossRefPubMedGoogle Scholar
  13. 13.
    Mann NC, Guice K, Cassidy L, Wright D, Koury J. Are statewide trauma registries comparable? Reaching for a national trauma dataset. Acad Emerg Med Off J Soc Acad Emerg Med. 2006;13(9):946–53.CrossRefGoogle Scholar
  14. 14.
    What Is the NTDS? 2017; Accessed Jan 22 2018.
  15. 15.
    •• Shafi S, Nathens AB, Parks J, Cryer HM, Fildes JJ, Gentilello LM. Trauma quality improvement using risk-adjusted outcomes. J Trauma. 2008;64(3):599–604. discussion 604–596. This citation highlights the variation in outcomes in ACS verified trauma centers, suggesting that the process of verification alone to confirm structures and processes of care does not assure consistent outcome. CrossRefPubMedGoogle Scholar
  16. 16.
    Hemmila MR, Nathens AB, Shafi S, Calland JF, Clark DE, Cryer HG, et al. The Trauma Quality Improvement Program: pilot study and initial demonstration of feasibility. J Trauma. 2010;68(2):253–62.CrossRefPubMedGoogle Scholar
  17. 17.
    • Hemmila MR, Cain-Nielsen AH, Wahl WL, Vander Kolk WE, Jakubus JL, Mikhail JN, et al. Regional collaborative quality improvement for trauma reduces complications and costs. J Trauma Acute Care Surg. 2015;78(1):78–87. This citation provides insights into the impact of a regional collaborative on accelerating performance improvement related to trauma. CrossRefPubMedGoogle Scholar
  18. 18.
    National Trauma Data Standard Data Dictionary. 2018; Accessed December 27th 2017.
  19. 19.
    Kilgo PD, Osler TM, Meredith W. The worst injury predicts mortality outcome the best: rethinking the role of multiple injuries in trauma outcome scoring. J Trauma. 2003;55(4):599–606. discussion 606–597CrossRefPubMedGoogle Scholar
  20. 20.
    Haider AH, Saleem T, Leow JJ, Villegas CV, Kisat M, Schneider EB, et al. Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact? J Am Coll Surg. 2012;214(5):756–68.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    •• Newgard CD, Fildes JJ, Wu L, Hemmila MR, Burd RS, Neal M, et al. Methodology and analytic rationale for the American College of Surgeons Trauma Quality Improvement Program. J Am Coll Surg. 2013;216(1):147–57. This citation provides the methodology that supports risk adjustment for ACS TQIP. CrossRefPubMedGoogle Scholar
  22. 22.
    Hemmila MR, Jakubus JL. Trauma quality improvement. Crit Care Clin. 2017;33(1):193–212.CrossRefPubMedGoogle Scholar
  23. 23.
    Byrne JP, Nathens AB, Gomez D, Pincus D, Jenkinson RJ. Timing of femoral shaft fracture fixation following major trauma: a retrospective cohort study of United States trauma centers. PLoS Med. 2017;14(7):e1002336.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Guillamondegui OD, Gunter OL, Hines L, et al. Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to improve surgical outcomes. J Am Coll Surg. 2012;214(4):709–14. discussion 714–706CrossRefPubMedGoogle Scholar
  25. 25.
    Benjamin E, Recinos G, Aiolfi A, Inaba K, Demetriades D. Pharmacological thromboembolic prophylaxis in traumatic brain injuries: low molecular weight heparin is superior to unfractionated heparin. Ann Surg. 2017;266(3):463–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Scarborough JE, Ingraham AM, Liepert AE, Jung HS, O'Rourke AP, Agarwal SK. Nonoperative management is as effective as immediate splenectomy for adult patients with high-grade blunt splenic injury. J Am Coll Surg. 2016;223(2):249–58.CrossRefPubMedGoogle Scholar
  27. 27.
    Using the Surgeon Specific Registry for CMS MIPS. 2017; Accessed January 31 2018.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Melissa A. Hornor
    • 1
    • 2
  • Christopher Hoeft
    • 3
  • Avery B. Nathens
    • 1
    • 3
    • 4
    • 5
    • 6
    • 7
  1. 1.Division of Research and Optimal Patient CareAmerican College of SurgeonsChicagoUSA
  2. 2.Department of SurgeryThe Ohio State University College of MedicineColumbusUSA
  3. 3.Trauma Quality Improvement ProgramAmerican College of SurgeonsChicagoUSA
  4. 4.Sunnybrook Research InstituteTorontoCanada
  5. 5.Sunnybrook Health Sciences CenterTorontoCanada
  6. 6.Department of SurgeryUniversity of TorontoTorontoCanada
  7. 7.Division of General SurgeryUniversity of TorontoTorontoCanada

Personalised recommendations