Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries

Berg, Johanna; Alvesson, Helle Mölsted; Roy, Nobhojit; Ekelund, Ulf; Bains, Lovenish; Sk, Chatterjee; Bhattacharjee, Prosanta Kumar; David, Siddarth; Gupta, Ruta; Kamble, Jyoti; Khajanchi, Monty; Lal, Pawanindra; Malhotra, Vikas; Meher, Ravi; Mishra, Anurag; Mohan, Lakshmeswar Nagaraj; Petzold, Max; Saxena, Ritu; Shrivastava, Prabhat; Singh, Ranjan; Soni, Kapil Dev; Sural, Sumit; Wärnberg, Martin Gerdin

doi:10.1136/bmjopen-2021-059948

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…In our previous study, the usefulness of the filters derived in Ghana and Cameroon were deemed high in India, compared to filters derived from high-income countries. 14…”

Section: Discussionmentioning

confidence: 99%

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Effects of trauma quality improvement program implementation on mortality: A nonrandomized controlled trial

Berg,

David,

Bakhshi

et al. 2024

Preprint

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Importance: Trauma causes over four million deaths annually, the majority of these in low− and middle−income countries. Implementing trauma quality improvement programs may improve outcomes, and though extensively used, high−quality evidence of their effectiveness is scarce. Objective: To assess if implementing a trauma quality improvement program using on audit filters improves trauma patients outcomes. Design: A controlled interrupted time-series study, the Trauma Audit Filter Trial (TAFT). Setting: A prospective, multi−center study across four tertiary care hospitals in urban India. Participants: Adult patients admitted to participating hospitals with a history of trauma, defined as having any of the external causes listed in block V01-Y36, chapter XX of the International Classification of Disease version 10 as reason for admission. Intervention: In the intervention arm, comprised of two hospitals, we implemented a trauma quality improvement program using audit filters after an observation period of one year. The remaining two hospitals, the control arm, continued baseline data collection during the entire study period, 2017 − 2022, with no intervention made. Main Outcomes: All−cause mortality (in−hospital and at 30 days). For time series analysis, we applied segmented regression with a generalized additive model (GAM) to assess the effect on in−hospital mortality. We performed secondary analysis applying difference−in−differences analysis with linear regression to assess the effect on in−hospital and 30−day mortality. The study was not adequately powered to do time series analysis on 30−day mortality. Results: We included 10143 patients, median age 35 (IQR 26 − 50), 83% men. Using time series analysis, we observed a significant reduction in in-hospital mortality (32% vs 24%; OR 0.57, 95% CI 0.41−0.79, p<0.001) in the intervention arm, with no significant change in the control arm. Using difference-in-differences analysis we found a significant reduction in 30-day mortality (39% vs 26%; −0.15 95% CI -0.19 to −0.11, p<0.001) and in-hospital mortality (32% vs 24%; −0.11 95% CI− 0.15 to −0.07, p<0.001). However, external factors such as the opening of a dedicated trauma center at one intervention hospital and the COVID−19 pandemic may have influenced these results. Conclusion: Implementing a trauma quality improvement program using audit filters may reduce mortality. More research is needed to confirm these findings across different settings and to understand what makes these programs efficient, useful and sustainable in terms of improving outcomes. Trial registration: Trauma Audit Filter Trial, ClinicalTrials.gov IDNCT03235388, https://clinicaltrials.gov/study/NCT03235388

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“…In our previous study, the usefulness of the filters derived in Ghana and Cameroon were deemed high in India, compared to filters derived from high-income countries. 14…”

Section: Discussionmentioning

confidence: 99%

“…We conducted an anonymous Delphi survey at each intervention site to select audit filters 14 . A list of all implemented audit filters is included as supplementary material.…”

Section: Methodsmentioning

confidence: 99%

Effects of trauma quality improvement program implementation on mortality: A nonrandomized controlled trial

Berg,

David,

Bakhshi

et al. 2024

Preprint

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“…They must also be audited, according to the study by Horton et al in 2017 28 . In accordance with this need to adapt studies to local realities, the filters selected in the work of Wu et al 29 , developed for the reality of Cameroon, are not identical to those used by Berg et al 30 , in India, or those evaluated in the study by Bieler et al 27 and Zhang, GX et al 10 .…”

Section: Methodsmentioning

confidence: 99%

Trauma Registry: Trauma Quality indicators analysis in hospitalized patients

PIVETTA,

ANTUNES,

SHIMODA

et al. 2024

Rev. Col. Bras. Cir.

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Purpose: to consolidate a Trauma Register (TR) trough REDCap data acquisition platform and to validate, in this context, local Quality Indicators (QI) as improvement opportunities in trauma management. Methods: continuous data acquisition of all patients admitted in Irmandade da Santa Casa de Misericórdia de São Paulo adult Trauma bay and it’s validation in REDCap platform; 6 months retrospective cohort of QI impact in length of hospitalar stay, complications and mortality. Fisher, Chi-squared, Wilcoxon and Kruskal-Wallis tests were used to correlate QIs fails with the endpoints, considering p<0.05 and CI <95% as statically significant. Results: 465 were admitted in Trauma bay, with 137 patients hospitalized (29.5%); the number of QIs compromised were related with more complications (p=0.075) and increased length of stay (p=0.028), especially the delay in open fracture’s surgical management, which increased the severe complications’ incidence (p=0.005). Conclusion: the REDCap data acquisition platform is useful as a tool for multi center TR implementation, from ethical and logistical point of view; nevertheless, the proposed QIs are validated as attention points in trauma management, allowing improvements in traumatized patients treatment.

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The effect of trauma quality improvement programme implementation on quality of life among trauma patients in urban India

Kapitan,

Berg,

David

et al. 2024

Preprint

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Trauma accounts for around 4.4 million deaths annually and is among the leading causes of death, disproportionately affecting low- and middle-income countries. Trauma quality improvement programmes may reduce adverse patient outcomes but lack robust evidence. This study assessed the effect of implementing a trauma quality improvement programme using audit filters on health-related quality of life in adult trauma patients in urban India. We conducted a controlled interrupted time series study (ClinicalTrials.gov IDNCT03235388) across four tertiary care university hospitals. Adult (≥18 years) trauma patients, who were alive at 90 days post-admission, were included. After a 14-month observation phase, two hospitals were randomized to the intervention arm and implemented the trauma quality improvement programme, while two control hospitals did not implement any interventions. The study spanned from 2017 to 2022. Health-related quality of life was assessed 90 days post-admission using the EuroQol 5-dimensions (EQ-5D) questionnaire. The main outcome was EQ-5D health status, scaled from 0 to 100, analyzed using a difference-in-differences (DiD) approach. Descriptive analysis was performed for the five individual EQ-5D dimensions. 2307 participants were eligible for the analyses. The DiD analysis showed a statistically significant reduction in the EQ-5D health status score in the intervention arm (DiD estimate -4.07 [95% CI: -7.00; -1.15]). For the 819 patients with major trauma, there was a more pronounced, but statistically insignificant reduction (DiD estimate -4.86 [95% CI: -9.87; 0.15]). In the intervention arm, mobility, self-care, and pain/discomfort improved, while usual activities and anxiety/depression worsened. Implementing trauma quality improvement programmes using audit filters may reduce the average health-related quality of life of trauma patients if more severely injured patients survive, highlighting the importance of assessing quality of life after the implementation of such programmes and ensuring adequate rehabilitation resources to support long-term recovery.

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Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries

Cited by 4 publications

References 16 publications

Effects of trauma quality improvement program implementation on mortality: A nonrandomized controlled trial

Effects of trauma quality improvement program implementation on mortality: A nonrandomized controlled trial

Trauma Registry: Trauma Quality indicators analysis in hospitalized patients

The effect of trauma quality improvement programme implementation on quality of life among trauma patients in urban India

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