[State of practice: portrait of the Quebec adult trauma care network: 2013 – 2016]

Gonthier C, Belcaïd A, Truchon C
Record ID 32018000898
Original Title: État des pratiques: portrait du réseau québécois de traumatologie adulte : 2013 à 2016
Authors' objectives: The trauma care services established in Quebec are organized on the basis of an integrated model offering accessible and quality services to trauma patients while conforming to principles of effectiveness and continuity of care. Implemented more than two decades ago, the Quebec trauma care network has undergone many monitoring cycles for its acute care facilities, and now an evaluation of the hospital services at a macro level has been carried out. This evaluation is intended to provide an overview of the Quebec adult trauma care network between 2013 and 2016 by describing the profile of patients who have sustained traumatic injuries, the care trajectories and the performance of the designated acute care trauma facilities using process and outcomes indicators. It also seeks to estimate the trauma admissions in all Quebec acute care facilities. This report complements a recent analysis of the pediatric trauma population published in 2018 by the Institut national d’excellence en santé et en services sociaux (INESSS).
Authors' results and conclusions: RESULTS: Between 2013 and 2016, 52,190 adult trauma patients were admitted to a facility in the Quebec trauma care network, i.e., approximately 17,400 cases per year. Admitted men were younger than women (mean age of 55.7 vs. 70.6 years, respectively), with falls responsible for the majority of traumatic injuries (68.3%), followed by motor vehicle accidents (16%). The most frequently diagnosed injuries were orthopedic injuries, which accounted for nearly 62% of all traumatic injuries. Nineteen percent (19%) of admitted patients – two-thirds of whom were men – sustained major traumatic injuries. The average hospital length of stay (LOS) was 11.5 days, of which 5.1 days were in intensive care. Severe burn injury (SBI) patients had the longest hospital LOS, averaging 27.1 days. Moderate or severe traumatic brain injury (TBI) and SBI patients accounted for the greatest number of deaths. Inter-facility transfer agreements have been established for specific trauma patients, such as patients with moderate or severe TBI, spinal cord injuries, SBI, those who have had a traumatic amputation or in need of an emergency microsurgical revascularization. These patients were usually admitted to appropriate acute care facilities or specifically designated centers of expertise as required. However, a certain number of such patients were still treated at other facilities within the network. Regarding the quality and performance of the Quebec adult trauma care network, the average compliance to the process indicators varied considerably between the adult facilities. Between 2013 and 2016, the provincial average for the 13 process indicators varied from 12% to 95.4%. Some of these indicators had a high average compliance, for example, airway protection in the emergency department (ED) for patients with a Glasgow Coma Scale score < 9, while other indicators could show an improvement, particularly the indicators for surgical delays or ED LOS. In terms of outcomes indicators, the results showed an adjusted mortality rate of 6.4% among all trauma victims. Those who sustained major injuries (ISS ≥ 12) had the highest proportions of mortality and major complications among the three groups studied, while unplanned readmissions and hospital LOS were higher among individuals aged 65 and older. Finally, among all trauma admissions recorded in Quebec’s acute care facilities between 2006 and 2016, 73.5% of all trauma cases and 88.1% of all major trauma patients were admitted to a designated trauma care facility. However, the proportion of admissions into the trauma care network decreases in older patients and is lower in women compared to men (69.1% and 78.2%, respectively). CONCLUSIONS: This evaluation of the Quebec adult trauma care network provided a comprehensive portrait of admitted trauma patients, of the care trajectories followed by patients with specific injuries as well as the network’s performance based on quality indicators. A comparison of trauma admissions in all acute care facilities in Quebec revealed that most victims were admitted to a designated trauma care facility. Major findings and avenues for reflection on potential actions are suggested in response to the concerns raised by the various analyses.
Authors' methods: The Quebec Trauma Registry was used to identify all trauma patients over the age of 16 who were admitted between 2013 and 2016 to one of the 57 designated adult trauma care facilities or to one of the five centers of expertise in Quebec. A description of patients admitted into the network (overall and by type of injury) and of their care trajectories was produced. Thirteen process indicators and four outcome indicators, risk-adjusted and broken down into three patient subgroups (all patients, major injuries [ISS ≥ 12] and patients aged 65 and older), were also used to measure the quality and performance of the designated adult trauma care facilities. Finally, in order to capture all trauma cases in Quebec, the MED-ÉCHO database was consulted to describe adult trauma admissions between 2006 and 2016 in an acute care facility in Quebec, whether or not it was specifically designated to provide trauma care.
Project Status: Completed
Year Published: 2019
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Traumatology
  • Registries
  • Program Evaluation
  • Trauma Centers
  • Transportation of Patients
  • Adult
  • Traumatology
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.