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Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review

BACKGROUND: Risk-adjusted mortality is widely used to benchmark trauma center care. Patients presenting with isolated hip fractures (IHFs) are usually excluded from these evaluations. However, there is no standardized definition of an IHF. We aimed to evaluate whether there is consensus on the defin...

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Autores principales: Tiao, Judith, Moore, Lynne, Boutin, Amélie, Turgeon, Alexis F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4126122/
https://www.ncbi.nlm.nih.gov/pubmed/25114432
http://dx.doi.org/10.4103/0974-2700.136867
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author Tiao, Judith
Moore, Lynne
Boutin, Amélie
Turgeon, Alexis F.
author_facet Tiao, Judith
Moore, Lynne
Boutin, Amélie
Turgeon, Alexis F.
author_sort Tiao, Judith
collection PubMed
description BACKGROUND: Risk-adjusted mortality is widely used to benchmark trauma center care. Patients presenting with isolated hip fractures (IHFs) are usually excluded from these evaluations. However, there is no standardized definition of an IHF. We aimed to evaluate whether there is consensus on the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers in terms of mortality. MATERIALS AND METHODS: We conducted a systematic review of observational studies. We searched the electronic databases MEDLINE, EMBASE, BIOSIS, The Cochrane Library, CINAHL, TRIP Database, and PROQUEST for cohort studies that presented data on mortality to assess the performance of trauma centers and excluded IHF. A standardized, piloted data abstraction form was used to extract data on study settings, IHF definitions and methodological quality of included studies. Consensus was considered to be reached if more than 50% of studies used the same definition of IHF. RESULTS: We identified 8,506 studies of which 11 were eligible for inclusion. Only two studies (18%) used the same definition of an IHF. Three (27%) used a definition based on Abbreviated Injury Scale (AIS) Codes and five (45%) on International Classification of Diseases (ICD) codes. Four (36%) studies had inclusion criteria based on age, five (45%) on secondary injuries, and four (36%) on the mechanism of injury. Eight studies (73%) had good overall methodological quality. CONCLUSIONS: We observed important heterogeneity in the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers. Consensus on a standardized definition is needed to improve the validity of evaluations of the quality of trauma care.
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spelling pubmed-41261222014-08-11 Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review Tiao, Judith Moore, Lynne Boutin, Amélie Turgeon, Alexis F. J Emerg Trauma Shock Evidence Based Medicine BACKGROUND: Risk-adjusted mortality is widely used to benchmark trauma center care. Patients presenting with isolated hip fractures (IHFs) are usually excluded from these evaluations. However, there is no standardized definition of an IHF. We aimed to evaluate whether there is consensus on the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers in terms of mortality. MATERIALS AND METHODS: We conducted a systematic review of observational studies. We searched the electronic databases MEDLINE, EMBASE, BIOSIS, The Cochrane Library, CINAHL, TRIP Database, and PROQUEST for cohort studies that presented data on mortality to assess the performance of trauma centers and excluded IHF. A standardized, piloted data abstraction form was used to extract data on study settings, IHF definitions and methodological quality of included studies. Consensus was considered to be reached if more than 50% of studies used the same definition of IHF. RESULTS: We identified 8,506 studies of which 11 were eligible for inclusion. Only two studies (18%) used the same definition of an IHF. Three (27%) used a definition based on Abbreviated Injury Scale (AIS) Codes and five (45%) on International Classification of Diseases (ICD) codes. Four (36%) studies had inclusion criteria based on age, five (45%) on secondary injuries, and four (36%) on the mechanism of injury. Eight studies (73%) had good overall methodological quality. CONCLUSIONS: We observed important heterogeneity in the definition of an IHF used as an exclusion criterion in studies evaluating the performance of trauma centers. Consensus on a standardized definition is needed to improve the validity of evaluations of the quality of trauma care. Medknow Publications & Media Pvt Ltd 2014 /pmc/articles/PMC4126122/ /pubmed/25114432 http://dx.doi.org/10.4103/0974-2700.136867 Text en Copyright: © Journal of Emergencies, Trauma, and Shock http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Evidence Based Medicine
Tiao, Judith
Moore, Lynne
Boutin, Amélie
Turgeon, Alexis F.
Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review
title Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review
title_full Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review
title_fullStr Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review
title_full_unstemmed Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review
title_short Establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: A systematic review
title_sort establishing consensus on the definition of an isolated hip fracture for trauma system performance evaluation: a systematic review
topic Evidence Based Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4126122/
https://www.ncbi.nlm.nih.gov/pubmed/25114432
http://dx.doi.org/10.4103/0974-2700.136867
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