Canadian benchmarks for acute injury care

BACKGROUND: Acute care injury outcomes vary substantially across Canadian provinces and trauma centres. Our aim was to develop Canadian benchmarks to monitor mortality and hospital length of stay (LOS) for injury admissions. METHODS: Benchmarks were derived using data from the Canadian National Trauma Registry on patients with major trauma admitted to any level I or II trauma centre in Canada and from the following patient subgroups: isolated traumatic brain injury (TBI), isolated thoracoabdominal injury, multisystem blunt injury, age 65 years or older. We assessed predictive validity using measures of discrimination and calibration, and performed sensitivity analyses to assess the impact of replacing analytically complex methods (multiple imputation, shrinkage estimates and flexible modelling) with simple models that can be implemented locally. RESULTS: The mortality risk adjustment model had excellent discrimination and calibration (area under the receiver operating characteristic curve 0.886, Hosmer-Lemeshow 36). The LOS risk-adjustment model predicted 29% of the variation in LOS. Overall, observed:expected ratios of mortality and mean LOS generated by an analytically simple model correlated strongly with those generated by analytically complex models (r > 0.95, κ on outliers > 0.90). CONCLUSION: Nous proposons des valeurs de reference canadiennes qui peuvent etre utilisees pour faire le suivi de la qualite des soins dans les centres de traumatologie canadiens a l'aide d'un simple programme Excel (voir les annexes, accessible a l'adresse canjsurg.ca). Le programme peut etre applique a l'aide des donnees des registres de traumatologie locaux a la condition qu'au moins 100 patients y soient accessibles pour analyse.