title: Complications to evaluate adult trauma care: An expert consensus study.
abstract: BACKGROUND
  Complications affect up to 37% of patients hospitalized for injury and increase mortality, morbidity, and costs. One of the keys to controlling complications for injury admissions is to monitor in-hospital complication rates. However, there is no consensus on which complications should be used to evaluate the quality of trauma care. The objective of this study was to develop a consensus-based list of complications that can be used to assess the acute phase of adult trauma care.
  
  
  METHODS
  We used a three-round Web-based Delphi survey among experts in the field of trauma care quality with a broad range of clinical expertise and geographic diversity. The main outcome measure was median importance rating on a 5-point Likert scale (very low to very high); complications with a median of 4 or greater and no disagreement were retained. A secondary measure was the perceived quality of information on each complication available in patient files.
  
  
  RESULTS
  Of 19 experts invited to participate, 17 completed the first (brainstorming) round and 16 (84%) completed all rounds. Of 73 complications generated in Round 1, a total of 25 were retained including adult respiratory distress syndrome, hospital-acquired pneumonia, sepsis, acute renal failure, deep vein thrombosis, pulmonary embolism, wound infection, decubitus ulcers, and delirium. Of these, 19 (76%) were perceived to have high-quality or very high-quality information in patient files by more than 50% of the panel members.
  
  
  CONCLUSIONS
  This study proposes a consensus-based list of 25 complications that can be used to evaluate the quality of acute adult trauma care. These complications can be used to develop an informative and actionable quality indicator to evaluate trauma care with the goal of decreasing rates of hospital complications and thus improving patient outcomes and resource use. DRG International Classification of Diseases codes are provided.
authors: From the Department of Social and Preventative Medicine (L.M., N.L.S., M.S., A.F.T.), Axe Santé des Populations - Pratiques Optimales en Santé (Population Health - Practice-Changing Research Unit), Traumatologie - Urgence - Soins Intensifs (Trauma - Emergency - Critical Care Medicine) (L.M., N.L.S., M.S., A.F.T.), Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus) (L.M., F.L., N.L.S., M.S., A.F.T.), and Department of Surgery (J.C.), Department of Anesthesiology (F.L., A.F.T.), Division of Critical Care Medicine, Université Laval, Quebec, Quebec; Department of Critical Care Medicine (H.T.S.), Medicine and Community Health Sciences, Institute for Public Health, University of Calgary, Calgary, Alberta; and Institut National d'excellence en Santé et en Services Sociaux (G.B.), Montreal, Quebec, Canada.
authors: Lynne
authors: L
authors: Moore
authors: François
authors: F
authors: Lauzier
authors: Henry Thomas
authors: HT
authors: Stelfox
authors: Natalie
authors: N
authors: Le Sage
authors: Gilles
authors: G
authors: Bourgeois
authors: Julien
authors: J
authors: Clément
authors: Michèle
authors: M
authors: Shemilt
authors: Alexis F
authors: AF
authors: Turgeon
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D003422:Critical Care / Q000592:standards*; D003428:Cross Infection / Q000209:etiology; D003693:Delirium / Q000209:etiology; D003697:Delphi Technique; D006801:Humans; D003668:Pressure Ulcer / Q000209:etiology; D011655:Pulmonary Embolism / Q000209:etiology; D011785:Quality Assurance, Health Care / Q000379:methods; D019984:Quality Indicators, Health Care; D012128:Respiratory Distress Syndrome / Q000209:etiology; D018805:Sepsis / Q000209:etiology; D014194:Traumatology / Q000592:standards; D020246:Venous Thrombosis / Q000209:etiology; D014946:Wound Infection / Q000209:etiology; D014947:Wounds and Injuries / Q000150:complications*