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Association between trauma quality indicators and outcomes for injured patients.

OBJECTIVE
To examine the association between the American College of Surgeons Committee on Trauma (ACSCOT) quality indicators and outcomes.


DESIGN
Cross-sectional study.


SETTING
Data from the Pennsylvania Trauma Outcome Study.


PATIENTS
We studied data from 210,942 patients admitted to 35 trauma centers in Pennsylvania between 2000 and 2009.


MAIN OUTCOME MEASURES
Regression analyses were performed to examine the association between ACSCOT quality indicators and in-hospital mortality and death or major complications.


RESULTS
Seven of the ACSCOT quality indicators were associated with either increased (1) in-hospital mortality or (2) death or major complications. No head computed tomography scan in patients with a Glasgow Coma Scale score less than 13 was associated with a 4-fold increase in mortality (adjusted odds ratio [AOR], 4.39; 95% confidence interval [CI], 3.18-6.07) and a nearly 3-fold increased risk of death or major complications (AOR, 2.76; 95% CI 2.05-3.72). Gunshot wounds to the abdomen managed nonoperatively were associated with a nearly 5-fold increase in mortality (AOR, 4.80; 95% CI, 2.95-7.81). Femoral fractures treated with nonfixation were also strongly associated with mortality (AOR, 4.08; 95% CI, 2.50-6.66) and death or major complications (AOR, 2.54; 95% CI, 1.96-3.31).


CONCLUSION
Several current ACSCOT quality indicators have a strong association with clinical outcomes. These findings should be interpreted with caution because some measures may lack face validity for identifying poor-quality care in complex patients with multiple injuries.