American College of Surgeons audit filters: associations with patient outcome and resource utilization

Abstract

Objective: To determine if trauma patients qualifying by a 1990 American College of Surgeons (ACS) audit filter have the same outcomes and resource utilizations as similar (matching) patients not qualifying by the filter.

Design: Retrospective, case control study.

Materials and methods: Data for 21,175 patients submitted during 1992 to the Pennsylvania Trauma Outcome Study (PTOS) were analyzed. Patients qualifying by each 1990 ACS audit filter were identified, except filters 13 and 22 that were not accommodated by the PTOS form. In addition, qualifiers by filter 21 (trauma deaths) were not analyzed. For each qualifier by a filter, matching patients who were not qualifiers by the filter were identified. Matching patients had the same cause of injury, A Severity Characterization of Trauma (ASCOT) age category, distribution of serious (Abbreviated Injury Score of > 2) injuries, intubation status, and coded Revised Trauma Score values on Emergency Department arrival. Qualifiers and matching patients were compared for their survival (z and W statistics), discharge disability (PTOS-Functional Independence Measure), and lengths of stay in the hospital (H-LOS) and in the Intensive Care Unit (ICU-LOS).

Measurements and main results: More than 57% of the study sample qualified by one or more filters. Filters 10 and 12 did not have sufficient qualifiers for evaluation. No filter's qualifiers were associated with significantly more disability at discharge than matching patients. The most frequently occurring filters (4, 2, and 5, respec-tively) deal with documentation deficiencies, but were not associated with significant results. Qualifiers by the nine filters below were associated with significantly greater mortality or H-LOS or ICU-LOS. [table: see text]

Conclusions: Additional studies of the efficacy and efficiency of trauma quality assurance filters are needed. Objective criteria should be established for the definition, evaluation, modification, and adoption of trauma audit filters.