Jeffcote Toby, Battistuzzo Camila R, Roach Rebecca, Bell Catherine, Bendinelli Cino, Rashford Stephen, Jithoo Ron, Gabbe Belinda J, Flower Oliver, O'Reilly Gerard, Campbell Lewis T, Cooper D James, Balogh Zsolt J, Udy Andrew A
Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
Neurocrit Care. 2025 Apr;42(2):485-494. doi: 10.1007/s12028-024-02107-x. Epub 2024 Sep 5.
The aim of this study was to develop a consensus-based set of indicators of high-quality acute moderate to severe traumatic brain injury (msTBI) clinical management that can be used to measure structure, process, and outcome factors that are likely to influence patient outcomes. This is the first stage of the PRECISION-TBI program, which is a prospective cohort study that aims to identify and promote optimal clinical management of msTBI in Australia.
A preliminary set of 45 quality indicators was developed based on available evidence. An advisory committee of established experts in the field refined the initial indicator set in terms of content coverage, proportional representation, contamination, and supporting evidence. The refined indicator set was then distributed to a wider Delphi panel for assessment of each indicator in terms of validity, measurement feasibility, variability, and action feasibility. Inclusion in the final indicator set was contingent on prespecified inclusion scoring.
The indicator set was structured according to the care pathway of msTBI and included prehospital, emergency department, neurosurgical, intensive care, and rehabilitation indicators. Measurement domains included structure indicators, logistic indicators, and clinical management indicators. The Delphi panel consisted of 44 participants (84% physician, 12% nursing, and 4% primary research) with a median of 15 years of practice. Of the 47 indicators included in the second round of the Delphi, 32 indicators were approved by the Delphi group.
This study identified a set of 32 quality indicators that can be used to structure data collection to drive quality improvement in the clinical management of msTBI. They will also be used to guide feedback to PRECISION-TBI's participating sites.
本研究的目的是制定一套基于共识的高质量急性中重度创伤性脑损伤（msTBI）临床管理指标，可用于衡量可能影响患者预后的结构、过程和结果因素。这是PRECISION - TBI项目的第一阶段，该项目是一项前瞻性队列研究，旨在确定并促进澳大利亚msTBI的最佳临床管理。
基于现有证据制定了一套初步的45项质量指标。该领域的权威专家组成的咨询委员会从内容覆盖、比例代表性、混杂性和支持证据等方面对初始指标集进行了完善。然后将完善后的指标集分发给更广泛的德尔菲专家组，以评估每个指标的有效性、测量可行性、变异性和行动可行性。最终指标集的纳入取决于预先设定的纳入评分。
指标集按照msTBI的护理路径构建，包括院前、急诊科、神经外科、重症监护和康复指标。测量领域包括结构指标、后勤指标和临床管理指标。德尔菲专家组由44名参与者组成（84%为医生，12%为护士，4%为基础研究人员），中位从业年限为15年。在第二轮德尔菲调查纳入的47项指标中，32项指标得到了德尔菲小组的认可。
本研究确定了一套32项质量指标，可用于构建数据收集，以推动msTBI临床管理的质量改进。它们还将用于指导向PRECISION - TBI参与站点提供反馈。
