3.12 Non-Trauma/Surgical Service Admissions

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Description of Indicator

Relationship to Quality Medical care should be efficient and effective
Type of Indicator Hospital process, Hospital level
Proposed Data Source Administrative Data
Definition Number of patients with major anatomic injuries* admitted under care of a non-trauma/surgical service‡ per 100 admissions*
Numerator All patients age 18 years and older admitted to hospital with a major anatomic injury diagnosis* under the care of a non-trauma/surgical service‡
Denominator All patients age 18 years and older admitted to hospital with a major anatomic injury* diagnosis
Benchmark Not specified at present
Risk Adjustment Not applicable

* Patient inclusion criteria for the indicator is based on major anatomic injuries derived from an expert panel on field triage published by the CDC9,10. The criteria were selected to make the indicator specific for identifying patients with major anatomic injuries that may benefit from admission to a trauma/surgical service.
Penetrating injury to head, neck, torso, extremities (proximal to elbow or knee)
Should severe blunt traumatic brain injury added to selection criteria?
Flail chest
> 2 proximal long-bone fractures
Crush, degloved or mangled extremity
Amputation proximal to wrist and ankle
Pelvic fracture
Open or depressed skull fracture
‡ ICUs that provide care for trauma or surgical patients are considered a trauma/surgical service for the purposes of this indicator.

This indicator is intended to monitor the clinical team to which injured patients are admitted.

Panel Review
Panelists noted that the goal of the indicator was to capture the admission of patients to services that are not used to dealing with severely injured patients. They reported that consideration should be given to co-admissions for patients with specific comorbidities and/or advanced age.

Trauma Center Review
The trauma centers noted that the defined criteria might be difficult to adhere to as many trauma centers have local admitting practices. They also agreed with the panelists’ suggestions of incorporating considerations for patients with specific comorbidities and/or advanced age.

Review of Literature & Evidence
Face Validity: No studies identified.
Construct Validity: One study showed that the quality indicator was associated with hospital mortality14. One study showed no significant association between the quality indicator and hospital mortality15.
Reliability: No studies identified.
Risk Adjustment: Not applicable.
Utilization: Non-Trauma/Surgical Service Admissions is used as an indicator by a small number of trauma centers: USA 2% (3/200), Canada 0% (0/35), Australasia 0% (0/12).
A multicenter study suggested that acute trauma patients received better nursing care when admitted to a trauma ward67.

The American College of Surgeons Committee on Trauma proposed the audit filter Trauma Patient Admitted to Hospital under Care of Admitting or Attending Physician who is not a Surgeon2.


2. American College of Surgeons Committee on Trauma. Resources for Optimal Care of the Injured Patient 2006. Chicago: American College of Surgeons; 2006.
9. Centers for Disease Control and Prevention (CDC). CDC - Injury Prevention and Control: Field Triage - Guidelines for the Field Triage of Injured Patients. 2011; http://www.cdc.gov/fieldtriage/index.html. Accessed July 8, 2012.
10. Sasser SM, Hunt RC, Sullivent EE, et al. Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep. 2009;58(RR-1):1-35.
14. Nayduch D, Moylan J, Snyder BL, Andrews L, Rutledge R, Cunningham P. American College of Surgeons trauma quality indicators: an analysis of outcome in a statewide trauma registry. J Trauma. 1994;37(4):565-573; discussion 573-565.
15. Copes WS, Staz CF, Konvolinka CW, Sacco WJ. American College of Surgeons audit filters: associations with patient outcome and resource utilization. J Trauma. 1995;38(3):432-438.
67. Lloyd JM, Elsayed S, Majeed A, et al. The practice of out-lying patients is dangerous: a multicentre comparison study of nursing care provided for trauma patients. Injury. 2005;36(6):710-713.