Department of Public Health, Center for Medical Decision Sciences, Erasmus MC- University Medical Center Rotterdam, Rotterdam, The Netherlands.
Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Crit Care. 2020 Mar 4;24(1):78. doi: 10.1186/s13054-020-2791-0.
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.
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.
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.
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.
The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).
本研究旨在验证先前发表的一套基于共识的创伤性脑损伤（TBI）患者在欧洲重症监护病房（ICU）管理质量指标集，并研究其在质量测量和改进方面的潜力。
我们的分析基于 2014 年至 2018 年期间纳入 CENTER-TBI 研究的 54 个 ICU 中 2006 名成年患者。结构和过程指标的指标得分计算为依从性的百分比，结果指标的计算为事件率或中位数评分。可行性通过变量的完整性来量化。辨别力通过中心间变异来确定，使用调整病例组合严重程度的随机效应回归模型进行估计，并通过中位数优势比（MOR）进行量化。使用每个中心 10 个事件的截止值来确定结果指标的统计不确定性。
共有 26/42 个指标可以从 CENTER-TBI 数据库中计算出来。大多数质量指标的获取完整性超过 70%，被认为是可行的。大多数质量指标的依从性较差，范围为 26%至 93%和 20%至 99%，结构和过程指标。7 个过程和 5 个结果指标的中心间变异具有统计学意义（p<0.001），MOR 范围为 1.51 至 4.14。结果指标的统计不确定性通常较高；7 个中有 5 个每个中心的事件少于 10 个。
总体而言，9 个结构、5 个过程，但没有一个结果指标显示出 ICU 中 TBI 患者质量改进的潜力。未来的研究应侧重于实施工作和对质量指标的持续重新评估。
核心研究在 ClinicalTrials.gov 上注册，编号为 NCT02210221，于 2014 年 8 月 6 日注册，资源标识门户（RRID：SCR_015582）。
