title: Trauma center performance indicators for nonfatal outcomes: a scoping review of the literature.
abstract: BACKGROUND
  According to Donabedian's framework, outcomes covering the following six domains should be used to evaluate health care quality: death, adverse events, readmissions to hospital, resource use, quality of life, and ability to function in daily activities. The objective of this study was to identify the nonfatal outcomes that have been used to evaluate the performance of trauma hospitals. Secondary objectives were to describe definitions and methodological quality.
  
  
  METHODS
  We performed a scoping literature review of studies using at least one nonfatal outcome to evaluate the performance of acute care hospitals for the treatment of general trauma populations. We searched MEDLINE, EMBASE, Cochrane central, CINAHL, BIOSIS, TRIP and ProQuest databases. Methodological quality was evaluated using elements of the STROBE statement and the Downs and Black tool.
  
  
  RESULTS
  Of 14,521 citations, 40 were eligible for inclusion. We identified 14 nonfatal outcomes as follows: (i) adverse events including complications (used in 35 evaluations), missed injuries (n = 4), reintubation (n = 2), unplanned intensive care unit admissions (n = 2), and unplanned surgeries (n = 4); (ii) resource use including hospital (n = 19), intensive care unit (n = 15), and ventilator (n = 4) length of stay, inappropriate hospital stay (n = 1), and potentially unnecessary care (n = 1); (iii) hospital readmissions (n = 4); and (iv) ability to function in daily activities including functional capacity (n = 2), and discharge destination (n = 3). No measures of quality of life were identified. There was high heterogeneity in the definitions used. Only 18% of studies had high methodological quality.
  
  
  CONCLUSIONS
  Among recommended domains of nonfatal outcomes, adverse events and resource use were frequently used to evaluate trauma care, readmissions and function in daily activities were rarely used, and quality of life was never used. In addition, definitions of nonfatal outcomes were variable, and methodological quality was low. There is a need to develop valid and reliable performance indicators based on each domain of Donabedian's framework to evaluate trauma care.
authors.affiliation: Department of Social and Preventative Medicine, Université Laval, Quebec City, Quebec, Canada. lynne.moore.cha@ssss.gouv.qc.ca
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: Henry Thomas
authors.initials: HT
authors.lastname: Stelfox
authors.forename: Amélie
authors.initials: A
authors.lastname: Boutin
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
mesh_terms: D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care / Q000592:standards*; D015203:Reproducibility of Results; D014193:Trauma Centers / Q000592:standards*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy