title: Evaluation of the influence of the definition of an isolated hip fracture as an exclusion criterion for trauma system benchmarking: a multicenter cohort study.
abstract: OBJECTIVE
  To assess whether the definition of an IHF used as an exclusion criterion influences the results of trauma center benchmarking.
  
  
  METHODS
  We conducted a multicenter retrospective cohort study with data from an integrated Canadian trauma system. The study population included all patients admitted between 1999 and 2010 to any of the 57 adult trauma centers. Seven definitions of IHF based on diagnostic codes, age, mechanism of injury, and secondary injuries, identified in a systematic review, were used. Trauma centers were benchmarked using risk-adjusted mortality estimates generated using the Trauma Risk Adjustment Model. The agreement between benchmarking results generated under different IHF definitions was evaluated with correlation coefficients on adjusted mortality estimates. Correlation coefficients >0.95 were considered to convey acceptable agreement.
  
  
  RESULTS
  The study population consisted of 172,872 patients before exclusion of IHF and between 128,094 and 139,588 patients after exclusion. Correlation coefficients between risk-adjusted mortality estimates generated in populations including and excluding IHF varied between 0.86 and 0.90. Correlation coefficients of estimates generated under different definitions of IHF varied between 0.97 and 0.99, even when analyses were restricted to patients aged ≥65 years.
  
  
  CONCLUSIONS
  Although the exclusion of patients with IHF has an influence on the results of trauma center benchmarking based on mortality, the definition of IHF in terms of diagnostic codes, age, mechanism of injury and secondary injury has no significant impact on benchmarking results. Results suggest that there is no need to obtain formal consensus on the definition of IHF for benchmarking activities.
authors.affiliation: Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada.|Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Tiao
authors.affiliation: Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada.|Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Moore
authors.affiliation: Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada. tvporgo@gmail.com.|Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada. tvporgo@gmail.com.
authors.forename: T V
authors.initials: TV
authors.lastname: Porgo
authors.affiliation: Axe Santé des Populations et Pratiques Optimales en Santé, Traumatologie-Urgence-Soins intensifs, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Belcaid
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D002170:Canada / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006620:Hip Fractures / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014218:Triage / Q000592:standards*; D055815:Young Adult
keywords: Definition; Exclusion criterion; Isolated hip fractures; Trauma system benchmarking