AMERICAN-COLLEGE OF SURGEONS AUDIT FILTERS - ASSOCIATIONS WITH PATIENT OUTCOME AND RESOURCE UTILIZATION

Objective: To determine if trauma patients qualifying by a 1990 Americ an College of Surgeons (ACS) audit filter have the same outcomes and r esource utilizations as similar (matching) patients not qualifying by the filter. Design: Retrospective, case control study. Materials and M ethods: Data for 21,175 patients submitted during 1992 to the Pennsylv ania Trauma Outcome Study (PTOS) were analyzed. Patients qualifying by each 1990 ACS audit filter were identified, except filters 13 and 22 that were not accommodated by the PTOS form. In addition, qualifiers b y filter 21 (trauma deaths) were not analyzed. For each qualifier by a filter, matching patients who were not qualifiers by the filter were identified. Matching patients had the same cause of injury, A Severity Characterization of Trauma (ASCOT) age category, distribution of seri ous (Abbreviated Injury Score of >2) injuries, intubation status, and coded Revised Trauma Score values on Emergency Department arrival. Qua lifiers and matching patients were compared for their survival (z and W statistics), discharge disability (PTOS-Functional Independence Meas ure), and lengths of stay in the hospital (H-LOS) and in the Intensive Care Unit (ICU-LOS). Measurements and Main Results: More than 57% of the study sample qualified by one or more fibers. Filters 10 and 12 di d not have sufficient qualifiers for evaluation. No filter's qualifier s were associated with significantly more disability at discharge than matching patients. The most frequently occurring filters (4, 2, and 5 , respectively) deal with documentation deficiencies, but were not ass ociated with significant results. Qualifiers by the nine filters below were associated with significantly greater mortality or H-LOS or ICU- LOS. GRAPHICS Conclusions: Additional studies of the efficacy and ef ficiency of trauma quality assurance filters are needed. Objective cri teria should be established for the definition, evaluation, modificati on, and adoption of trauma audit filters.