Are the ACSCOT filters associated with outcome? Examining morbidity and mortality in a European setting.
BACKGROUND
Quality indicators are widely needed for external assessment and comparison of trauma care. It is common to extend the use of the American College of Surgeons Committee on Trauma (ACSCOT) audit filters to this scope. This mandates that their actual link with outcome be demonstrated. Several studies attempted to do so, but with inconsistent risk-adjustment, conflicting results and never using long-term disability as outcome measure, despite its recognised importance. We tried to overcome these limitations.


METHODS
Risk-adjusted analysis of the association of filters 1, 3, 10 and 13 with 30-day mortality and 6-month disability measured with the EQ5D scale. Multivariate logistic and linear regression models were used respectively. The data came from a National Italian Trauma Registry comprising 838 patients with major trauma.


RESULTS
Three (1, 3 and 10) of the filters analysed did not show any significant association with either outcome. Filter 13 was associated with decreased mortality and lower (worse) disability scores.


CONCLUSIONS
Methodological difficulties, incomplete, obsolete or non-generalizable definitions of some filters can explain the generally poor correlation with outcomes. The conflicting association of filter 13 with the two types of outcomes raises some interesting questions about the targeted outcomes in trauma research. It is recommended that further studies develop better quality indicators and test their link with both survival and functional outcome in the same setting where they are applied for assessment and comparison of trauma care.
Di Bartolomeo
Stefano
S
Cattedra di Epidemiologia, University of Udine, Via Colugna 40, 33100 Udine, Italy. stefano.dibartolomeo@uniud.it
Valent
Francesca
F
Sanson
Gianfranco
G
Nardi
Giuseppe
G
Gambale
Giorgio
G
Barbone
Fabio
F
D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012955:Societies, Medical / Q000592:standards; D014193:Trauma Centers / Q000592:standards; D014947:Wounds and Injuries / Q000401:mortality*