title: Quality indicators in pediatric orthopaedic surgery: a systematic review.
abstract: BACKGROUND
  The ability to measure health system quality has become a priority for governments, the private sector, and the public. Quality indicators (QIs) refer to clear, measurable items related to outcomes. The use of QIs can initiate local quality improvement and track changes in quality over time as interventions are implemented.
  
  
  OBJECTIVE
  We identified existing evidence-based indicators of quality pediatric orthopaedic care and evaluated published QIs that may be applicable to pediatric orthopaedic care.
  
  
  METHODS
  Using five standard search engines we searched the literature using terms such as "quality indicators," "orthopaedic surgery," and "pediatric." Study selection was performed in a stepwise manner, first by title, then abstract, and then full-text review. Of the 604 citations identified, 13 articles were selected for inclusion. Eight papers included only pediatric patients.
  
  
  RESULTS
  The most commonly reported indicator was mortality followed by postoperative complications. Reoperation and readmission rates were also reported along with patient-centered QIs, although with less frequency.
  
  
  CONCLUSIONS
  Although mortality and postoperative complications were the most frequently reported QIs, concern for their applicability was raised because of their relative infrequency in pediatrics. Patient-centered QIs appear to be the most useful tools reported, although their use is somewhat limited in the published literature. Although there are benefits and drawbacks to all reported QIs, patient-centered and surgeon-defined outcomes along with cost-effectiveness have important roles in evaluating the quality of pediatric orthopaedic care.
authors.affiliation: Division of Orthopaedic Surgery, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Kennedy
authors.forename: Christina
authors.initials: C
authors.lastname: Bakir
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Brauer
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D006801:Humans; D019637:Orthopedic Procedures / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*