Quality indicators for patients with traumatic brain injury in European intensive care units: a CENTER-TBI study
Creators
-
Huijben, Jilske A.1
- Wiegers, Eveline J. A.1
- Ercole, Ari2
- de Keizer, Nicolette F.3
- Maas, Andrew I. R.4
- Steyerberg, Ewout W.1
-
Citerio, Giuseppe5
- Wilson, Lindsay6
- Polinder, Suzanne1
- Nieboer, Daan1
- Menon, David2
- Lingsma, Hester F.1
- van der Jagt, Mathieu7
- the CENTER-TBI investigators and participants for the ICU stratum
- 1. Department of Public Health, Center for Medical Decision Sciences, Erasmus MC– University Medical Center Rotterdam, Rotterdam, The Netherlands
- 2. Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- 3. Department of Medical Informatics, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- 4. Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
- 5. School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- 6. Division of Psychology, University of Stirling, Stirling, UK
- 7. Department of Intensive Care Adults, Erasmus MC– University Medical Center Rotterdam, Rotterdam, The Netherlands
Description
Background: The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement.
Methods: Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10.
Results: A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p < 0.001) between-centre variation was found in seven process and five outcome indicators with MORs ranging from 1.51 to 4.14. Statistical uncertainty of outcome indicators was generally high; five out of seven had less than 10 events per centre.
Conclusions: Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators.
Trial registration: The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).
Files
13054_2020_Article_2791.pdf
Files
(1.9 MB)
| Name | Size | Download all |
|---|---|---|
|
md5:6403f770e2ff15a1b9369223f90c4dd3
|
14.6 kB | Download |
|
md5:c986820d805dfda1f1a909c7affdfcee
|
15.7 kB | Download |
|
md5:9793c76c2e04cd27391dba978d393a97
|
17.9 kB | Download |
|
md5:d2ad867addf809488772aa91ca84e636
|
16.6 kB | Download |
|
md5:ef7ac03fe34eabbabf733bd2dbcec245
|
26.4 kB | Download |
|
md5:0935f088212de5df8126c13a43c6e4a5
|
1.8 MB | Preview Download |
|
md5:f8d7824849630f429bae8945e1e70e25
|
34.7 kB | Download |