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. 2025 Apr;42(2):485-494.
doi: 10.1007/s12028-024-02107-x. Epub 2024 Sep 5.

Development of a Quality Indicator Set for the Optimal Acute Management of Moderate to Severe Traumatic Brain Injury in the Australian Context

Toby Jeffcote  1   2 , Camila R Battistuzzo  2 , Rebecca Roach  1 , Catherine Bell  1 , Cino Bendinelli  3 , Stephen Rashford  4 , Ron Jithoo  5 , Belinda J Gabbe  6 , Oliver Flower  7 , Gerard O'Reilly  6   8 , Lewis T Campbell  9 , D James Cooper  1   2 , Zsolt J Balogh  3 , Andrew A Udy  10   11 ; Delphi panel
Collaborators, Affiliations

Development of a Quality Indicator Set for the Optimal Acute Management of Moderate to Severe Traumatic Brain Injury in the Australian Context

Toby Jeffcote et al. Neurocrit Care. 2025 Apr.

Abstract

Background: The aim of this study was to develop a consensus-based set of indicators of high-quality acute moderate to severe traumatic brain injury (msTBI) clinical management that can be used to measure structure, process, and outcome factors that are likely to influence patient outcomes. This is the first stage of the PRECISION-TBI program, which is a prospective cohort study that aims to identify and promote optimal clinical management of msTBI in Australia.

Methods: A preliminary set of 45 quality indicators was developed based on available evidence. An advisory committee of established experts in the field refined the initial indicator set in terms of content coverage, proportional representation, contamination, and supporting evidence. The refined indicator set was then distributed to a wider Delphi panel for assessment of each indicator in terms of validity, measurement feasibility, variability, and action feasibility. Inclusion in the final indicator set was contingent on prespecified inclusion scoring.

Results: The indicator set was structured according to the care pathway of msTBI and included prehospital, emergency department, neurosurgical, intensive care, and rehabilitation indicators. Measurement domains included structure indicators, logistic indicators, and clinical management indicators. The Delphi panel consisted of 44 participants (84% physician, 12% nursing, and 4% primary research) with a median of 15 years of practice. Of the 47 indicators included in the second round of the Delphi, 32 indicators were approved by the Delphi group.

Conclusions: This study identified a set of 32 quality indicators that can be used to structure data collection to drive quality improvement in the clinical management of msTBI. They will also be used to guide feedback to PRECISION-TBI's participating sites.

Keywords: Benchmarking; Critical care; Quality indicators; Quality of care; Traumatic brain injuries.

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Conflict of interest statement

Conflict of interest: The authors declare that they have no conflicts of interest. Ethical Approval/Informed Consent: Not applicable.

Figures

Fig. 1
Fig. 1
Overview of the Delphi process. There two rounds in this Delphi process involving the advisory committee and the panel of experts. two rounds of members of the advisory committee rating a total of 45 indicators. A total of 32 indicators were included in the final set. Agreement was defined as a median Likert score of 4 (agreement) or 5 (strong agreement). Consensus was defined as an interquartile range of < 1 on scores for validity and < 2 for all other criteria
Fig. 2
Fig. 2
List of removed quality indicators. Details of the 15 indicators removed during the Delphi process. GOSE, Glasgow Outcome Scale-Extended, ICU, intensive care unit, TBI, traumatic brain injury
Fig. 3
Fig. 3
List of final quality indicators set for acute management of msTBI in Australia. AUC, area under the curve, CPP, cerebral perfusion pressure, CT, computed tomography, DVT, deep vein thrombosis, EVD, extra ventricular drain, ICU, intensive care unit, ICP, intracranial pressure, IQD, interquartile range, msTBI, moderate to severe traumatic brain injury, PRx, pressure reactivity index, SDH, acute subdural hematoma, TBI, traumatic brain injury
See this image and copyright information in PMC

References

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