Abstract
BackgroundThe aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement.MethodsOur analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10.ResultsA total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p < 0.001) between-centre variation was found in seven process and five outcome indicators with MORs ranging from 1.51 to 4.14. Statistical uncertainty of outcome indicators was generally high; five out of seven had less than 10 events per centre.ConclusionsOverall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators.Trial registrationThe core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).
Highlights
The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement
A total of 26 (11 structure, 8 process, and 7 outcome indicators) of the 42 indicators of the Delphi set could be extracted from the CENTER-TBI database. (Additional file 1)
We showed that it was feasible to obtain most quality indicators from a recently proposed, consensus-based, quality indicator set for traumatic brain injury (TBI) at the ICU based on sufficient data completeness
Summary
The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement. Limited evidence is available to direct critical care practice in patients with traumatic brain injury (TBI) [1]. Randomized controlled trials have shown a limited potential to add evidence translatable to clinical practice, and new approaches are being explored to improve care, such as quality of care monitoring. Benchmarking TBI management between ICUs can only be reliable when standardized quality indicators are used and case-mix correction is applied [5]. As no quality indicator set is available for patients with TBI, we recently performed a Delphi study to reach consensus on a quality indicator set [10]
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