title: Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review.
abstract: BACKGROUND
  Risk-adjusted mortality is widely used to benchmark trauma center care. Patients presenting with isolated hip fractures (IHFs) are usually excluded from these evaluations. However, there is no standardized definition of an IHF. We aimed to evaluate whether there is consensus on the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers in terms of mortality.
  
  
  METHODS
  We conducted a systematic review of observational studies. We searched the electronic databases MEDLINE, EMBASE, BIOSIS, The Cochrane Library, CINAHL, TRIP Database, and PROQUEST for cohort studies that presented data on mortality to assess the performance of trauma centers and excluded IHF. A standardized, piloted data abstraction form was used to extract data on study settings, IHF definitions and methodological quality of included studies. Consensus was considered to be reached if more than 50% of studies used the same definition of IHF.
  
  
  RESULTS
  We identified 8,506 studies of which 11 were eligible for inclusion. Only two studies (18%) used the same definition of an IHF. Three (27%) used a definition based on Abbreviated Injury Scale (AIS) Codes and five (45%) on International Classification of Diseases (ICD) codes. Four (36%) studies had inclusion criteria based on age, five (45%) on secondary injuries, and four (36%) on the mechanism of injury. Eight studies (73%) had good overall methodological quality.
  
  
  CONCLUSIONS
  We observed important heterogeneity in the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers. Consensus on a standardized definition is needed to improve the validity of evaluations of the quality of trauma care.
authors.affiliation: Department of Social and Preventive Medicine;, Université Laval, Québec, Canada ; Axe Santé des populations et pratiques optimales en santé (traumatologie-urgence-soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, Canada.
authors.forename: Judith
authors.initials: J
authors.lastname: Tiao
authors.affiliation: Department of Social and Preventive Medicine;, Université Laval, Québec, Canada ; Axe Santé des populations et pratiques optimales en santé (traumatologie-urgence-soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, Canada.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.affiliation: Axe Santé des populations et pratiques optimales en santé (traumatologie-urgence-soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, Canada.
authors.forename: Amélie
authors.initials: A
authors.lastname: Boutin
authors.affiliation: Axe Santé des populations et pratiques optimales en santé (traumatologie-urgence-soins intensifs), Centre de Recherche du CHU de Québec - Hôpital de l'Enfant-Jésus, Université Laval, Québec, Canada ; Department of Anesthesiology, Division of Critical Care Medicine, Quebec, Canada.
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
keywords: Benchmarking; consensus; definition; isolated hip fractures; mortality; systematic review; trauma
references.citation: J Trauma. 2005 Apr;58(4):793-7
references.pmid: 15824658
references.citation: J Epidemiol Community Health. 1998 Jun;52(6):377-84
references.pmid: 9764259
references.citation: J Trauma. 2006 Jun;60(6):1238-43; discussion 1243-4
references.pmid: 16766966
references.citation: Ann Intern Med. 2007 Oct 16;147(8):573-7
references.pmid: 17938396
references.citation: J Trauma. 2011 Mar;70(3):575-82
references.pmid: 21610345
references.citation: J Trauma. 2010 Aug;69(2):245-52
references.pmid: 20699731
references.citation: Ann Surg. 2010 May;251(5):952-8
references.pmid: 20395844
references.citation: J Trauma. 2009 May;66(5):1321-6
references.pmid: 19430234
references.citation: J Trauma. 2006 Feb;60(2):305-11
references.pmid: 16508487
references.citation: J Trauma. 2010 Nov;69(5):1037-41
references.pmid: 21068608
references.citation: BMJ. 2008 Jul 31;337:a744
references.pmid: 18669566
references.citation: Acad Emerg Med. 2010 Jul;17(7):701-8
references.pmid: 20653583
references.citation: Ann Surg. 2011 Jan;253(1):144-50
references.pmid: 21233613
references.citation: J Trauma. 2006 Feb;60(2):300-4
references.pmid: 16508486
references.citation: Acad Emerg Med. 2006 Sep;13(9):946-53
references.pmid: 16902047
references.citation: BMJ. 2011 Oct 18;343:d5928
references.pmid: 22008217
references.citation: J Trauma. 2000 Apr;48(4):629-34; discussion 635-6
references.pmid: 10780594
references.citation: J Am Geriatr Soc. 2004 Dec;52(12):2023-30
references.pmid: 15571537