Evaluation Of Trauma Care Research Articles

Exploring trauma surgeons' views on trauma care in Nigeria: A qualitative study

BackgroundIn Nigeria, trauma care faces challenges due to high injury and death rates from road traffic accidents and violence. Improvements are underway, but gaps in service availability, training, and coordination persist, necessitating evidence-based interventions. PurposeTo evaluate trauma care practices in Nigeria, focusing on practitioners' perceptions of training, resources, and care quality to inform policy and practice enhancements. MethodsAn exploratory qualitative study was conducted with seven trauma surgeons across Nigeria, using semi-structured interviews and an Interpretive Description analysis approach, adhering to SRQR standards. ResultsAnalysis of interviews with seven Nigerian trauma surgeons highlighted a trauma care system burdened by high incidences of traffic-related injuries. Despite varying caseloads—from 20 cases per month to 65 weekly—common challenges included delayed care, leading to complications like infection and misaligned wound healing. Surgeons noted strengths in motivated staff and sub-specialization but stressed barriers such as underdeveloped prehospital care, financial constraints, and resource shortages, which hindered effective trauma management and outcomes. ConclusionsEffective trauma care in Nigeria is crucial and achievable through policy reforms, better resource distribution, and enhanced training. Systematic data collection and a national trauma care protocol are recommended to improve patient outcomes and guide future research and policymaking.

Comparing health status after major trauma across different levels of trauma care.

Mortality due to trauma has reduced the past decades. Trauma network implementations have been an important contributor to this achievement. Besides mortality, patient reported outcome parameters should be included in evaluation of trauma care. While concentrating major trauma care, hospitals are designated with a certain level of trauma care following specific criteria. Comparing health status of major trauma patients after two years across different levels of trauma care in trauma networks. Multicentre observational study comprising a secondary longitudinal multilevel analysis on prospective cohorts from two neighbouring trauma regions in the Netherlands. patient aged ≥ 18 with an ISS > 15 surviving their injuries at least one year after trauma. Health status was measured one and two years after trauma by EQ-5D-5L, added with a sixth health dimension on cognition. Level I trauma centres were considered as reference in uni- and multivariate analysis. Respondents admitted to a level I trauma centre scored less favourable EQ-US and EQ-VAS in both years (0.81-0.81, 71-75) than respondents admitted to a level II (0.88-0.87, 78-85) or level III (0.89-0.88, 75-80) facility. Level II facilities scored significantly higher EQ-US and EQ-VAS in time for univariate analysis (β 0.095, 95% CI 0.038-0.153, p=0.001, and β 7.887, 95% CI 3.035-12.740, p=0.002), not in multivariate analysis (β 0.052, 95% CI -0.010-0.115, p=0.102, and β 3.714, 95% CI -1.893-9.321, p=0.193). Fewer limitations in mobility (OR 0.344, 95% CI 0.156-0.760), self-care (OR 0.219, 95% CI 0.077-0.618), and pain and discomfort (OR 0.421, 95% CI 0.214-0.831) remained significant for level II facilities in multivariate analysis, whereas significant differences with level III facilities disappeared. Major trauma patients admitted to level I trauma centres reported a less favourable general health status and more limitations compared to level II and III facilities scoring populations norms one to two years after trauma. Differences on general health status and limitations in specific health domains disappeared in adjusted analysis. Well-coordinated trauma networks offer homogeneous results for all major trauma patients when they are distributed in different centres according to their need of care.

Designing and conducting initial application of a performance assessment model for in-hospital trauma care

BackgroundTrauma is a major cause of death worldwide, especially in Low and Middle-Income Countries (LMIC). The increase in health care costs and the differences in the quality of provided services indicates the need for trauma care evaluation. This study was done to develop and use a performance assessment model for in-hospital trauma care focusing on traffic injures.MethodsThis multi-method study was conducted in three main phases of determining indicators, model development, and model application. Trauma care performance indicators were extracted through literature review and confirmed using a two-round Delphi survey and experts’ perspectives. Two focus group discussions and 16 semi-structured interviews were conducted to design the prototype. In the next step, components and the final form of the model were confirmed following pre-determined factors, including importance and necessity, simplicity, clarity, and relevance. Finally, the model was tested by applying it in a trauma center.ResultsA total of 50 trauma care indicators were approved after reviewing the literature and obtaining the experts’ views. The final model consisted of six components of assessment level, teams, methods, scheduling, frequency, and data source. The model application revealed problems of a selected trauma center in terms of information recording, patient deposition, some clinical services, waiting time for deposit, recording medical errors and complications, patient follow-up, and patient satisfaction.ConclusionPerformance assessment with an appropriate model can identify deficiencies and failures of services provided in trauma centers. Understanding the current situation is one of the main requirements for designing any quality improvement programs.

Evaluating Trauma Care Capabilities using the Essential Trauma Care Guidelines of the World Health Organization: Cross-sectional study of primary health centres in Muscat, Oman.

ObjectivesThis study aimed to evaluate trauma care capabilities at the primary care level in Muscat, Oman, using World Health Organization guidelines.MethodsThis descriptive cross-sectional study was conducted between January and March 2015 at eight primary health centres in Seeb. An English-language questionnaire was distributed to the medical officer or nurse in-charge at each centre to determine the number of staff, total population being served, number of emergency trauma cases and availability of ambulances. Subsequently, 10 doctors from each health centre were randomly selected to assess the availability of physical resources as well as their trauma skills and knowledge.ResultsThere were limited physical and human resources for the management of trauma and a complete absence of trauma administrative functions, such as local trauma registries or quality improvement activities.ConclusionThis study highlighted the need to introduce national guidelines and improve the delivery of trauma services in Oman.

Defining adverse events during trauma resuscitation: a modified RAND Delphi study

BackgroundThe majority of preventable adverse event (AEs) in trauma care occur during the initial phase of resuscitation, often within the trauma bay. However, there is significant heterogeneity in reporting these...

52739 Trauma Care in Nigeria and Recommendations for Sustainable Improvement to Nigeria’s Trauma Care System: A Systematic Literature Review

ABSTRACT IMPACT: This work highlighs the significant burden of Trauma in Nigeria and will help inform policy decisions on improving Nigeri’s current Trauma care system OBJECTIVES/GOALS: To evaluate trauma care delivery at the pre-hospital, hospital and health systems level in Nigeria in order to identify the burden of trauma, gaps in the delivery of trauma care, and interventions, implemented or recommended, to improve upon the limitations to trauma care delivery. METHODS/STUDY POPULATION: A two-concept search - one being trauma and the other being Nigeria - of the Pubmed (Medline) and Embase databases, in addition to Global Index Medicus and grey literature was performed between September 2018 and September 2019. The search yielded 3,970 articles that underwent title screening and 331 articles that underwent abstract screening. 101 articles were identified for full text screening and the majority were extracted for inclusion into the review. The extracted literature was grouped into 4 categories - articles outlining the burden of trauma in Nigeria, and articles outlining the delivery of trauma care at the pre-hospital, hospital and health systems level. RESULTS/ANTICIPATED RESULTS: Results were classified as an identified challenge or an intervention, recommended or implemented, to address Nigeria’s trauma care system. There was a highlighted need for pre-hospital infrastructure, training of frontline providers, continued competency assessments of frontline providers, in-hospital diagnostic resources, and trauma care surveillance systems to guide health policy. DISCUSSION/SIGNIFICANCE OF FINDINGS: There is a significant burden of trauma in Nigeria. Coordinated interventions and policies at the pre-hospital level, the hospital level, as well as the health systems level are needed in order to address the gaps in Nigeria’s current trauma care system.

A pragmatic evaluation of trauma care: an evidence from the province of Punjab, Pakistan

Road Traffic Accident (RTA) injuries pose a public health challenge which significantly impacts the human capital development. The Punjab Economic Research Institute (PERI) conducted a study to assess the frequency, causes of trauma injuries, distribution and need and gap analysis of trauma centers in the province of Punjab. For gap/situational analysis, information was extracted through a structured questionnaire from randomly selected 8 District Head Quarters hospitals, 6 Teaching hospitals and 8 independent trauma centers. According to the data of Rescue 1122, 70% of RTA injuries involved the age group 11-40 years. In 295589(63.26%) of the RTA cases the vehicle involved was a motorbike. The major RTA injuries were leg fractures 71699 (16.44%) and head injuries 44738(10.26%). Over speeding 159977(44%) and careless driving 121545 (33.35%) were the major causes of RTAs. Noted was a shortage and mismatch between human resources and equipment in the trauma treatment facilities. Inequality was also found in distribution of trauma care units. Integrated and fully equipped trauma care system along with the establishment of trauma centers in places of high accidents' frequency is recommended. Strict implementation of road traffic safety laws is mandatory.

Evaluating trauma care, outcomes and costs in a system in crisis: the necessity of a Greek National Trauma Database

BackgroundAt present there is no organized trauma system in Greece and no national trauma database. The objective of this study was to record and evaluate trauma management at our university...

A bibliometric analysis of publications on trauma in critical care medicine during 1980-2018: A holistic view.

There is not a holistic bibliometric study evaluating the publications in the literature even though trauma is a paramount subject in the field of critical care. This study aimed to investigate the important articles and journals receiving the most citations and publishing the most articles, revealing international cooperation and uncovering trend topics in this subject as a consequence of analyzing articles on trauma in the field of critical care published between 1980 and 2018 using bibliometric analysis methods. Publication scan in this study was performed using Web of Science (WoS) database. Literature review was limited to only publications indexed in the field of Critical Care. "Trauma" was used as the keyword to reach relevant publications. Linear regression analysis was performed to predict the number of articles foreseen to be published in the upcoming years in the subject of trauma. As a result of the literature review, a total of 10851 publications were found. Six thousand four hundred and eighty-nine (59.8%) of these publications were under the category of article. First three countries with the most publications were respectively as the United States of America (4096) (63.1%), Canada (401) and Germany (380). Turkey ranked 21 with 41 publications. The article titled "Evaluating trauma care - the triss method" published in 1987 had received the most citations. The journal with the most publications and citations was "Journal of Trauma Injury Infection and Critical Care". This study will be a useful guide to all scientists and clinicians conducting research on trauma in critical care.

Developing Performance Indicators for Trauma Care: A Four-Stage Qualitative Study

Background: Trauma is considered one of the major causes of death around the world. Increased costs of healthcare and differences in the quality of services among trauma centers indicate that measuring the performance of trauma care is necessary. Objectives: the present study aimed to develop some trauma care performance indicators. Methods: This study was implemented between September 2017 and October 2018 in a four-stage process: a comprehensive literature review, sessions with a panel of five experts, two focus group discussions, sixteen semi-structured interviews, and a two-round Delphi survey. The study setting was East Azerbaijan province, Iran. Forty-six experts in different fields of medical sciences confirmed applicable indicators for trauma care assessment. Results: A total of 140 indicators were found through a comprehensive literature review. After conducting expert panels, focus group discussions, and interviews, the number of indicators decreased to 57 cases and were entered into the Delphi survey. In the first phase of the Delphi survey, content validity ratio (CVR), content validity indicator (CVI), and modified kappa values were 0.64, 0.85, and 0.83, respectively. Sixteen indicators were changed or deleted and 6 indicators were separated. The members of the final expert panel agreed on 50 indicators in the second phase of the Delphi survey after omitting 7 indicators. Conclusion: Performanceindicators for trauma care evaluation were introduced in this study. They can be used by policymakers and health service providers to assess and improve performance and compare trauma centers in Iran and developing countries that have health systems similar to the Iranian health system.

A new weighted injury severity scoring system: better predictive power for adult trauma mortality

BackgroundAn accurate injury severity measurement is essential in the evaluation of trauma care and in outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions, and the three AIS involved in the calculation of ISS are given equal weights. The objective of this study was to develop a weighted injury severity scoring (wISS) system for adult trauma patients with better predictive power than the traditional Injury Severity Score (ISS).MethodsThe 2007–2014 National Trauma Data Bank (NTDB) Research Datasets were used. We identified adult trauma patients from the NTDB and then randomly split it into a study sample and a test sample. Based on the association between mortality and the Abbreviated Injury Scale (AIS) from each of the six ISS body regions in the study sample, we evaluated 12 different sets of weights for the component AIS scores used in the calculation of ISS and selected one best set of weights. Discrimination (areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, concordance) and calibration were compared between the wISS and ISS.ResultsThe areas under the receiver operating characteristic curves from the wISS and ISS are all 0.83, and 0.76 vs. 0.73 for patients with ISS = 16–74 and 0.68 vs. 0.53 for patients with ISS = 25–74. The wISS showed higher specificity, positive predictive value, negative predictive value, and concordance when they were compared at similar levels of sensitivity. The wISS had better calibration than the ISS.ConclusionsBy weighting the AIS from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured adults.

Improvement of the performance of survival prediction in the ageing blunt trauma population: A cohort study.

IntroductionThe overestimation of survival predictions in the ageing trauma population results in negative benchmark numbers in hospitals that mainly treat elderly patients. The aim of this study was to develop and validate a modified Trauma and Injury Severity Score (TRISS) for accurate survival prediction in the ageing blunt trauma population.MethodsThis retrospective study was conducted with data from two Dutch Trauma regions. Missing values were imputed. New prediction models were created in the development set, including age (continuous or categorical) and Anesthesiologists Physical Status (ASA). The models were externally validated. Subsets were created based on age (≥75 years) and the presence of hip fracture. Model performance was assessed by proportion explained variance (Nagelkerke R2), discrimination (Area Under the curve of the Receiver Operating Characteristic, AUROC) and visually with calibration plots. A final model was created based on both datasets.ResultsNo differences were found between the baseline characteristics of the development dataset (n = 15,530) and the validation set (n = 15,504). The inclusion of ASA in the prediction models showed significant improved discriminative abilities in the two subsets (e.g. AUROC of 0.52 [95% CI: 0.46, 0.58] vs. 0.74 [95% CI: 0.69, 0.78] for elderly patients with hip fracture) and an increase in the proportion explained variance (R2 = 0.32 to R2 = 0.35 in the total cohort). The final model showed high agreement between observed and predicted survival in the calibration plot, also in the subsets.ConclusionsIncluding ASA and age (continuous) in survival prediction is a simple adjustment of the TRISS methodology to improve survival predictions in the ageing blunt trauma population. A new model is presented, through which even patients with isolated hip fractures could be included in the evaluation of trauma care.

Performance of the modified TRISS for evaluating trauma care in subpopulations: A cohort study

IntroductionPrevious research showed that there is no agreement on a practically applicable model to use in the evaluation of trauma care. A modification of the Trauma and Injury Severity Score (modified TRISS) is used to evaluate trauma care in the Netherlands. The aim of this study was to evaluate the prognostic ability of the modified TRISS and to determine where this model needs improvement for better survival predictions. MethodsPatients were included if they were registered in the Brabant Trauma Registry from 2010 through 2015. Missing values were imputed according to multiple imputation. Subsets were created based on age, length of stay, type of injury and injury severity. Probability of survival was calculated with the modified TRISS. Discrimination was assessed with the Area Under the Receiver Operating Curve (AUROC). Calibration was studied graphically. ResultsThe AUROC was 0.84 (95% CI: 0.83, 0.85) for the total cohort (N = 69 747) but only 0.53 (95% CI: 0.51, 0.56) for elderly patients with hip fracture. Overall, calibration of the modified TRISS was adequate for the total cohort, with an overestimation for elderly patients and an underestimation for patients without brain injury. ConclusionsOutcome comparison conducted with TRISS-based predictions should be interpreted with care. If possible, future research should develop a simple prediction model that has accurate survival prediction in the aging overall trauma population (preferable with patients with hip fracture), with readily available predictors.

Long-term health status and trajectories of seriously injured patients: A population-based longitudinal study.

BackgroundImproved understanding of the quality of survival of patients is crucial in evaluating trauma care, understanding recovery patterns and timeframes, and informing healthcare, social, and disability service provision. We aimed to describe the longer-term health status of seriously injured patients, identify predictors of outcome, and establish recovery trajectories by population characteristics.Methods and findingsA population-based, prospective cohort study using the Victorian State Trauma Registry (VSTR) was undertaken. We followed up 2,757 adult patients, injured between July 2011 and June 2012, through deaths registry linkage and telephone interview at 6-, 12-, 24-, and 36-months postinjury. The 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3L) was collected, and mixed-effects regression modelling was used to identify predictors of outcome, and recovery trajectories, for the EQ-5D-3L items and summary score. Mean (SD) age of participants was 50.8 (21.6) years, and 72% were male. Twelve percent (n = 333) died during their hospital stay, 8.1% (n = 222) of patients died postdischarge, and 155 (7.0%) were known to have survived to 36-months postinjury but were lost to follow-up at all time points. The prevalence of reporting problems at 36-months postinjury was 37% for mobility, 21% for self-care, 47% for usual activities, 50% for pain/discomfort, and 41% for anxiety/depression. Continued improvement to 36-months postinjury was only present for the usual activities item; the adjusted relative risk (ARR) of reporting problems decreased from 6 to 12 (ARR 0.87, 95% CI: 0.83–0.90), 12 to 24 (ARR 0.94, 95% CI: 0.90–0.98), and 24 to 36 months (ARR 0.95, 95% CI: 0.95–0.99). The risk of reporting problems with pain or discomfort increased from 24- to 36-months postinjury (ARR 1.06, 95% CI: 1.01, 1.12). While loss to follow-up was low, there was responder bias with patients injured in intentional events, younger, and less seriously injured patients less likely to participate; therefore, these patient subgroups were underrepresented in the study findings.ConclusionsThe prevalence of ongoing problems at 3-years postinjury is high, confirming that serious injury is frequently a chronic disorder. These findings have implications for trauma system design. Investment in interventions to reduce the longer-term impact of injuries is needed, and greater investment in primary prevention is needed.

Designing trauma registry system using a logical framework approach

While trauma registries provide the mechanisms to collect comprehensive, timely and accurate data related to the injuries and evaluate trauma care systems, they have not been established in most developing countries. On the other hand, in complex projects that have large aims, a logical framework approach (LFA) can help summarize and describe the multiple branches of the project systematically, and elucidate the main goals, extensive objectives, activities and expected outcomes. Therefore a LFA can be used to design and guide trauma registry project management, to integrate the cultural, clinical and capacity variations among countries; and to ensure early alignment of the project’s design and evaluation.

Donabedian's structure-process-outcome quality of care model: Validation in an integrated trauma system.

According to Donabedian's health care quality model, improvements in the structure of care should lead to improvements in clinical processes that should in turn improve patient outcome. This model has been widely adopted by the trauma community but has not yet been validated in a trauma system. The objective of this study was to assess the performance of an integrated trauma system in terms of structure, process, and outcome and evaluate the correlation between quality domains. Quality of care was evaluated for patients treated in a Canadian provincial trauma system (2005-2010; 57 centers, n = 63,971) using quality indicators (QIs) developed and validated previously. Structural performance was measured by transposing on-site accreditation visit reports onto an evaluation grid according to American College of Surgeons criteria. The composite process QI was calculated as the average sum of proportions of conformity to 15 process QIs derived from literature review and expert opinion. Outcome performance was measured using risk-adjusted rates of mortality, complications, and readmission as well as hospital length of stay (LOS). Correlation was assessed with Pearson's correlation coefficients. Statistically significant correlations were observed between structure and process QIs (r = 0.33), and process and outcome QIs (r = -0.33 for readmission, r = -0.27 for LOS). Significant positive correlations were also observed between outcome QIs (r = 0.37 for mortality-readmission; r = 0.39 for mortality-LOS and readmission-LOS; r = 0.45 for mortality-complications; r = 0.34 for readmission-complications; 0.63 for complications-LOS). Significant correlations between quality domains observed in this study suggest that Donabedian's structure-process-outcome model is a valid model for evaluating trauma care. Trauma centers that perform well in terms of structure also tend to perform well in terms of clinical processes, which in turn has a favorable influence on patient outcomes. Prognostic study, level III.

What is the effect of a formalised trauma tertiary survey procedure on missed injury rates in multi-trauma patients? Study protocol for a randomised controlled trial.

BackgroundMissed injury is commonly used as a quality indicator in trauma care. The trauma tertiary survey (TTS) has been proposed to reduce missed injuries. However a systematic review assessing the effect of the TTS on missed injury rates in trauma patients found only observational studies, only suggesting a possible increase in early detection and reduction in missed injuries, with significant potential biases. Therefore, more robust methods are necessary to test whether implementation of a formal TTS will increase early in-hospital injury detection, decrease delayed diagnosis and decrease missed injuries after hospital discharge.Methods/DesignWe propose a cluster-randomised, controlled trial to evaluate trauma care enhanced with a formalised TTS procedure. Currently, 20 to 25% of trauma patients routinely have a TTS performed. We expect this to increase to at least 75%. The design is for 6,380 multi-trauma patients in approximately 16 hospitals recruited over 24 months. In the first 12 months, patients will be randomised (by hospital) and allocated 1:1 to receive either the intervention (Group 1) or usual care (Group 2). The recruitment for the second 12 months will entail Group 1 hospitals continuing the TTS, and the Group 2 hospitals beginning it to enable estimates of the persistence of the intervention. The intervention is complex: implementation of formal TTS form, small group education, and executive directive to mandate both. Outcome data will be prospectively collected from (electronic) medical records and patient (telephone follow-up) questionnaires. Missed injuries will be adjudicated by a blinded expert panel. The primary outcome is missed injuries after hospital discharge; secondary outcomes are maintenance of the intervention effect, in-hospital missed injuries, tertiary survey performance rate, hospital and ICU bed days, interventions required for missed injuries, advanced diagnostic imaging requirements, readmissions to hospital, days of work and quality of life (EQ-5D-5 L) and mortality.DiscussionThe findings of this study may alter the delivery of international trauma care. If formal TTS is (cost-) effective this intervention should be implemented widely. If not, where already partly implemented, it should be abandoned. Study findings will be disseminated widely to relevant clinicians and health funders.Trial registrationANZCTR: ACTRN12613001218785, prospectively registered, 5 November 2013Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0733-y) contains supplementary material, which is available to authorized users.

Using population-based critical care data to evaluate trauma outcomes

BackgroundThe analysis of mortality is an integral part of the evaluation of trauma care. When specific data are not available, general prediction models can be used to adjust for case mix. The aim of this study was to evaluate the feasibility of conducting a population-based analysis of trends in trauma mortality, using critical care audit data, and to investigate whether such data could provide a benchmark for the assessment of service reconfiguration. MethodsRetrospective cohort study of adult trauma patients, requiring admission to a critical care unit in Scotland, 2002–2011, using nationally collected data. Results are presented as standardised mortality ratios of observed mortality divided by APACHE II predicted mortality. Tests for trends in numbers and ratios over time were performed using linear regression. Findings4503 patients were identified. There was a significant increase in the number of trauma patients admitted per year (p = 0.011). The median predicted probability of in-hospital death was 7% (interquartile range 1–13%), against an actual mortality was 11.6%. There was no significant change in the standardised mortality ratios of trauma patients (p = 0.1224). ConclusionsThis study demonstrated the feasibility of utilising critical care unit audit data for analysing outcomes from trauma care. It also showed the potential of such an approach to establish a baseline against which to compare the impact of future service reconfiguration. In contrast to healthcare systems with regionalised trauma care, there appears to have been little change in the mortality of trauma patients requiring critical care unit admission in Scotland.

Evaluating trauma care: comparison of early versus late tracheostomy ICU data outcome on injured patients

In the surgical ICU, bedside tracheostomy (T) is one of the most frequently applied surgical techniques for multi-injured patients mainly with TBI [1]. The optimum surgical time decision for T still remains a contradiction in trauma. This retrospective study was designed to register all trauma patients who underwent T, during 60 months of observation (2009 to 2013), in order to identify factors associated with their ICU outcome on the basis of the T day (A B) after tracheal intubation.

Derivation and validation of a quality indicator of acute care length of stay to evaluate trauma care.

To derive and internally validate a quality indicator (QI) for acute care length of stay (LOS) after admission for injury. Unnecessary hospital days represent an estimated 20% of total LOS implying an important waste of resources as well as increased patient exposure to hospital-acquired infections and functional decline. This study is based on a multicenter, retrospective cohort from a Canadian provincial trauma system (2005-2010; 57 trauma centers; n = 57,524). Data were abstracted from the provincial trauma registry and the hospital discharge database. Candidate risk factors were identified by expert consensus and selected for model derivation using bootstrap resampling. The validity of the QI was evaluated in terms of interhospital discrimination, construct validity, and forecasting. The risk adjustment model explains 37% of the variation in LOS. The QI discriminates well across trauma centers (coefficient of variation = 0.02, 95% confidence interval: 0.011-0.028) and is correlated with the QI on processes of care (r = -0.32), complications (r = 0.66), unplanned readmissions (r = 0.38), and mortality (r = 0.35). Performance in 2005 to 2007 was predictive of performance in 2008 to 2010 (r = 0.80). We have developed a QI on the basis of risk-adjusted LOS to evaluate trauma care that can be implemented with routinely collected data. The QI is based on a robust risk adjustment model with good internal and temporal validity, and demonstrates good properties in terms of discrimination, construct validity, and forecasting. This QI can be used to target interventions to reduce LOS, which will lead to more efficient resource use and may improve patient outcomes after injury.