title: Validation of Complications Selected by Consensus to Evaluate the Acute Phase of Adult Trauma Care: A Multicenter Cohort Study.
abstract: OBJECTIVE
  Evaluate the predictive validity of complications derived using expert consensus methodology to monitor the quality of trauma care. Secondary objectives were to assess the predictive validity of complications not selected by consensus and identify determinants of complications.
  
  
  BACKGROUND
  A list of complications to monitor the quality of trauma care has recently been derived using Delphi consensus methodology. However, the predictive validity of consensus complications has not yet been demonstrated.
  
  
  METHODS
  We conducted a multicenter cohort study of adults admitted to the 57 adult trauma centers of a Canadian integrated trauma system (2007-2012; n = 84,216). Multiple generalized linear models were used to assess the influence of complications on mortality and acute care length of stay (LOS) and to identify determinants of consensus complications.
  
  
  RESULTS
  The presence of at least 1 consensus complication was associated with a 2.7-fold [95% confidence interval (CI): 2.45-2.90] and 2.2-fold (95% CI: 2.11-2.19) increase in the odds of mortality and mean LOS, respectively. Nonselected complications were associated with no increase in mortality (odds ratio = 0.90, 95% CI: 0.80-1.01) and a 60% increase in LOS (geometric mean ratio = 1.60, 95% CI: 1.57-1.62). Patient-related factors and factors related to treatment explained 66% and 34% of the variation in complication rates, respectively.
  
  
  CONCLUSIONS
  In addition to the face and content validity ensured by consensus methodology, this study suggests that consensus complications have good predictive validity. Monitoring these complications as part of quality improvement activities would provide an opportunity to improve outcome and resource use for injury admissions.
authors.affiliation: *Department of Social and Preventative Medicine, Université Laval, Québec, Canada †Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada ‡Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, Canada §Department of Medicine, Université Laval, Québec, Canada ¶Department of Critical Care Medicine, Medicine and Community Health Sciences (HTS), Institute for Public Health, University of Calgary, Calgary, Alberta, Canada ||Department of Surgery, Division of General Surgery and Division of Critical Care, University of Calgary, Calgary, Alberta, Canada **Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada ††Institut national d'excellence en santé et en services sociaux (INESSS), Québec, Canada ‡‡Department of Surgery, Université Laval, Québec, Canada.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: François
authors.initials: F
authors.lastname: Lauzier
authors.forename: Henry Thomas
authors.initials: HT
authors.lastname: Stelfox
authors.forename: John
authors.initials: J
authors.lastname: Kortbeek
authors.forename: Richard
authors.initials: R
authors.lastname: Simons
authors.forename: Gilles
authors.initials: G
authors.lastname: Bourgeois
authors.forename: Julien
authors.initials: J
authors.lastname: Clément
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032921:Consensus; D003697:Delphi Technique; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D011792:Quebec; D012189:Retrospective Studies; D014193:Trauma Centers / Q000592:standards*; D014194:Traumatology / Q000592:standards*; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality / Q000628:therapy; D055815:Young Adult