title: Barriers to compliance with evidence-based care in trauma.
abstract: BACKGROUND
  We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care.
  
  
  METHODS
  Records of a random sample of 774 patients admitted to a Level I trauma center (2006-2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus. These encompassed all aspects of trauma care, including initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention. Multivariate logistic regression was used to identify patients likely to receive recommended care.
  
  
  RESULTS
  Study patients were eligible for a total of 2,603 T-POC, of which only 1,515 (58%) were provided to the patient. Compliance was highest for T-POC involving resuscitation (83%) and was lowest for neurosurgical interventions (17%). Increasing severity of head injuries was associated with lower compliance, while intensive care unit stay was associated with higher compliance. There was no relationship between compliance and patient demographics, socioeconomic status, overall injury severity, or daily volume of trauma admissions.
  
  
  CONCLUSIONS
  Little over half of recommended care was delivered to trauma patients with moderate to severe injuries. Patients with increasing severity of traumatic brain injuries were least likely to receive optimal care. However, differences among patient subgroups are small in relation to the overall gap between observed and recommended care.
  
  
  METHODS
  II.
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas 76051, USA.
authors.forename: Nadine
authors.initials: N
authors.lastname: Rayan
authors.forename: Sunni
authors.initials: S
authors.lastname: Barnes
authors.forename: Neil
authors.initials: N
authors.lastname: Fleming
authors.forename: Rustam
authors.initials: R
authors.lastname: Kudyakov
authors.forename: David
authors.initials: D
authors.lastname: Ballard
authors.forename: Larry M
authors.initials: LM
authors.lastname: Gentilello
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers