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Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review.

Tiao J, Moore L, Boutin A, Turgeon AF - J Emerg Trauma Shock (2014)

Bottom Line: Three (27%) used a definition based on Abbreviated Injury Scale (AIS) Codes and five (45%) on International Classification of Diseases (ICD) codes.Four (36%) studies had inclusion criteria based on age, five (45%) on secondary injuries, and four (36%) on the mechanism of injury.Eight studies (73%) had good overall methodological quality.

View Article: PubMed Central - PubMed

Affiliation: Department of Social and Preventive Medicine;, Université Laval, Québec, Canada ; Axe Santé des populations et pratiques optimales en santé (traumatologie-urgence-soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, Canada.

ABSTRACT

Background: Risk-adjusted mortality is widely used to benchmark trauma center care. Patients presenting with isolated hip fractures (IHFs) are usually excluded from these evaluations. However, there is no standardized definition of an IHF. We aimed to evaluate whether there is consensus on the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers in terms of mortality.

Materials and methods: We conducted a systematic review of observational studies. We searched the electronic databases MEDLINE, EMBASE, BIOSIS, The Cochrane Library, CINAHL, TRIP Database, and PROQUEST for cohort studies that presented data on mortality to assess the performance of trauma centers and excluded IHF. A standardized, piloted data abstraction form was used to extract data on study settings, IHF definitions and methodological quality of included studies. Consensus was considered to be reached if more than 50% of studies used the same definition of IHF.

Results: We identified 8,506 studies of which 11 were eligible for inclusion. Only two studies (18%) used the same definition of an IHF. Three (27%) used a definition based on Abbreviated Injury Scale (AIS) Codes and five (45%) on International Classification of Diseases (ICD) codes. Four (36%) studies had inclusion criteria based on age, five (45%) on secondary injuries, and four (36%) on the mechanism of injury. Eight studies (73%) had good overall methodological quality.

Conclusions: We observed important heterogeneity in the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers. Consensus on a standardized definition is needed to improve the validity of evaluations of the quality of trauma care.

No MeSH data available.


Related in: MedlinePlus

Selection of articles for review
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Figure 1: Selection of articles for review

Mentions: The search strategy identified 8,506 references of which 58 were selected for final review because they evaluated hospital performance on general trauma populations using mortality data [Figure 1]. Of these, 11 (19%) reported that they excluded patients with IHF and were therefore included in our study.[1112131415161718192021]


Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review.

Tiao J, Moore L, Boutin A, Turgeon AF - J Emerg Trauma Shock (2014)

Selection of articles for review
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126122&req=5

Figure 1: Selection of articles for review
Mentions: The search strategy identified 8,506 references of which 58 were selected for final review because they evaluated hospital performance on general trauma populations using mortality data [Figure 1]. Of these, 11 (19%) reported that they excluded patients with IHF and were therefore included in our study.[1112131415161718192021]

Bottom Line: Three (27%) used a definition based on Abbreviated Injury Scale (AIS) Codes and five (45%) on International Classification of Diseases (ICD) codes.Four (36%) studies had inclusion criteria based on age, five (45%) on secondary injuries, and four (36%) on the mechanism of injury.Eight studies (73%) had good overall methodological quality.

View Article: PubMed Central - PubMed

Affiliation: Department of Social and Preventive Medicine;, Université Laval, Québec, Canada ; Axe Santé des populations et pratiques optimales en santé (traumatologie-urgence-soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, Canada.

ABSTRACT

Background: Risk-adjusted mortality is widely used to benchmark trauma center care. Patients presenting with isolated hip fractures (IHFs) are usually excluded from these evaluations. However, there is no standardized definition of an IHF. We aimed to evaluate whether there is consensus on the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers in terms of mortality.

Materials and methods: We conducted a systematic review of observational studies. We searched the electronic databases MEDLINE, EMBASE, BIOSIS, The Cochrane Library, CINAHL, TRIP Database, and PROQUEST for cohort studies that presented data on mortality to assess the performance of trauma centers and excluded IHF. A standardized, piloted data abstraction form was used to extract data on study settings, IHF definitions and methodological quality of included studies. Consensus was considered to be reached if more than 50% of studies used the same definition of IHF.

Results: We identified 8,506 studies of which 11 were eligible for inclusion. Only two studies (18%) used the same definition of an IHF. Three (27%) used a definition based on Abbreviated Injury Scale (AIS) Codes and five (45%) on International Classification of Diseases (ICD) codes. Four (36%) studies had inclusion criteria based on age, five (45%) on secondary injuries, and four (36%) on the mechanism of injury. Eight studies (73%) had good overall methodological quality.

Conclusions: We observed important heterogeneity in the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers. Consensus on a standardized definition is needed to improve the validity of evaluations of the quality of trauma care.

No MeSH data available.


Related in: MedlinePlus