Anesthesia Management: Guideline Compliance for Trauma Patients: Room for Improvement

Authors: Shafi S et al., J Am Coll Surg 2014 Aug 219:189

In this study of five trauma centers, compliance with clinical practice guidelines varied widely, and increased compliance was associated with reduced risk for death.

To determine if there is an association between trauma guideline compliance and mortality rates in moderately and severely injured patients, researchers performed a retrospective review of 3867 patients admitted to five Level 1 trauma centers in the U.S. The practice management guidelines were developed by major organizations and focused on the initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention associated with traumatic brain injury, hemorrhagic shock, pelvic fractures, and long-bone extremity fractures.

Clinical Practices Associated with Reduced Risk for Death in Trauma Patients

Median compliance with the 22 individual recommended clinical practices was 83% overall and ranged from 67% to 100% at the different centers. After adjusting for patient demographics and injury severity, each 10% increase in compliance was associated with a 14% decrease in risk for death. Compliance with 11 therapeutic and diagnostic interventions was associated with reduced risk for death; compliance with more than one of these practices was associated with longer hospital stay.

Comment

Perhaps compliance is just one marker of a high-performing trauma center. As the authors correctly note, additional studies are needed to determine which clinical practices are associated with improved outcomes for trauma patients. While the American College of Surgeons trauma center verification process focuses on availability of appropriate resources, evaluating compliance with proven core practice measures emphasizes the quality of the actual care provided, which is a matter of at least equal importance.