BENCHMARKING THE QUALITY-MONITORING PROCESS - A COMPARISON OF OUTCOMES ANALYSIS BY TRAUMA AND INJURY SEVERITY SCORE (TRISS) METHODOLOGY WITH THE PEER-REVIEW PROCESS
Wf. Fallon et al., BENCHMARKING THE QUALITY-MONITORING PROCESS - A COMPARISON OF OUTCOMES ANALYSIS BY TRAUMA AND INJURY SEVERITY SCORE (TRISS) METHODOLOGY WITH THE PEER-REVIEW PROCESS, The journal of trauma, injury, infection, and critical care, 42(5), 1997, pp. 810-815
Background: One measure of optimal function within a trauma center is
the ability to critically examine outcomes from the process of care wi
thin the institution, yet guidelines for evaluation of the peer-review
process are lacking. This study was conducted to determine the correl
ation between mortality analysis performed by the peer-review process
(PR) within a trauma division and outcome analysis as determined by Tr
auma and Injury Severity Score (TRISS) methodology. Methods: The morta
lity peer-review data for an entire year at our level I trauma center
served as the study population, Information was obtained on probabilit
y of survival, and a determination of preventability was made using st
andard, preexisting criteria, Peer review involves assigning each outc
ome to a specific category through tile process of multidisciplinary a
ssessment, Probability of survival data was not used for this purpose,
Kappa analysis was performed to determine the degree of agreement in
each category and then tested for significance, Results: One hundred f
our deaths in 1,868 trauma patients (5.5%) were reviewed at our multid
isciplinary conference, Outcomes were judged as preventable, potential
ly preventable, or nonpreventable. Death directly related to exsanguin
ation was typically categorized as potentially preventable. Kappa anal
ysis demonstrated the greatest agreement between PR and TRISS in the n
onpreventable category (kappa = 0.213) and the least agreement in the
potentially preventable category (kappa -0.197), Overall, the kappa Z
statistic was nonsignificant (Z = 1.24). Conclusions: Multidisciplinar
y peer-review outcomes analysis is at least as effective as the comput
er-generated TRISS probability of survival data for evaluating quality
of care in a trauma center and may be more effective for analysis of
potentially preventable outcomes.