Centro de Informática e Investigación Clínica (CIIC), Rosario, Sante Fe, Argentina.
Hospital del Niños Sor María Ludovica, La Plata, Provincia de Buenos Aires, Argentina.
J Surg Res. 2021 Sep;265:71-78. doi: 10.1016/j.jss.2021.03.024. Epub 2021 Apr 20.
Trauma quality improvement (QI) programs improve care and outcomes for injured patients. Information about QI programs for pediatric traumatic brain injury (TBI) is sparse in Latin America.
We gathered data on the status of QI programs and activities that encompass pediatric TBI at 15 Argentine hospitals. Data were gathered during 2019 and included hospital characteristics, QI practices, presence of a queryable registry, and use of protocols for TBI care. Level of QI activities was compared between hospital types using Fisher's exact test.
Most hospitals had guidelines for pediatric TBI care, including management and/or prevention of intracranial pressure (100%) and central-line-associated infections (87%). Morbidity and mortality meetings or other types of case discussions in which quality of pediatric TBI care was discussed were held by all hospitals, with most (53%) having weekly-monthly meetings, but 27% having rare or annual meetings. Sixty percent of hospitals had adequate data for case reviews (fewer than 25% of cases with essential information missing). Fifty-three percent documented discussions that occurred at these meetings and 53% utilized computerized trauma registries. Larger hospitals (> 200 beds) more frequently had adequate data (88%) for case reviews than smaller hospitals (29%, P = 0.046). Hospital size did not affect other QI activities.
Most hospitals had guidelines for pediatric TBI care. Adequacy of care was discussed at reasonably frequent case conferences. Opportunities for improvement include increasing documentation of case reviews and improving adequacy of data for case reviews, especially at smaller hospitals. Greater use of computerized trauma registries could provide such data.
创伤质量改进（QI）计划可改善受伤患者的护理和结局。拉丁美洲有关儿科创伤性脑损伤（TBI）QI 计划的信息很少。
我们收集了 15 家阿根廷医院涵盖儿科 TBI 的 QI 计划和活动的数据。数据于 2019 年收集，包括医院特征、QI 实践、可查询登记处的存在以及 TBI 护理协议的使用。使用 Fisher 精确检验比较不同类型医院的 QI 活动水平。
大多数医院都有儿科 TBI 护理指南，包括颅内压（100%）和中心静脉相关感染（87%）的管理和/或预防。所有医院都举行了与儿科 TBI 护理质量相关的发病率和死亡率会议或其他类型的病例讨论，其中大多数（53%）每周/每月举行会议，但 27%的会议很少或每年举行一次。60%的医院有足够的数据进行病例回顾（少于 25%的病例关键信息缺失）。53%的医院记录了这些会议上的讨论情况，53%的医院使用了计算机化创伤登记处。较大的医院（>200 张床位）比较小的医院（29%，P=0.046）更频繁地有足够的数据进行病例回顾。医院规模不影响其他 QI 活动。
大多数医院都有儿科 TBI 护理指南。在相当频繁的病例会议上讨论了护理的充分性。改进的机会包括增加病例回顾的记录和提高病例回顾数据的充分性，特别是在较小的医院。更多地使用计算机化创伤登记处可以提供此类数据。
