Validation of Quality Indicators for Pediatric Trauma Care

Abstract

Objective: Develop metrics for pediatric-specific quality indicators (QIs) for trauma care using trauma registry data and evaluate their validity.

Summary background data: A set of 23 QIs specific to pediatric trauma care and applicable to both pediatric and non-pediatric trauma centers was recently developed. Their validity needs to be assessed prior to implementation.

Methods: We extracted data on children admitted to any trauma center in a Canadian provincial trauma system between April 2016 and March 2022. We evaluated QIs using Agency for Healthcare Research and Quality criteria.

Results: The study sample comprised 10,711 pediatric trauma admissions. We developed metrics for 15 QIs. Six had moderate-to-high validity on all evaluable criteria: head computed tomography <60 minutes for children with Glasgow Coma Scale<13, documentation of a full set of vital signs in the ED, initial head CT in patients at low-risk on a clinical decision rule, stabilization of femoral shaft fractures <24 hours, intracranial pressure monitoring in severe TBI, and nutritional support <48 hours of intensive care unit admission. Four had moderate-to-high validity on all but one criterion: PTC transfer for neurotrauma and major multisystem trauma, PTC transfer for major orthopedic trauma, and antibiotics <60 minutes in open long bone fractures.

Conclusions: This study shows the feasibility of operationalizing QIs for pediatric trauma using trauma registry data and we provide coding definitions to do so. Results provide evidence on validity that may be used to guide the selection of QIs for performance improvement programs.

Keywords: pediatric trauma; quality indicators; validation.