Background The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement. Methods Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10. Results A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant ( p < 0.001) between-centre variation was found in seven process and five outcome indicators with MORs ranging from 1.51 to 4.14. Statistical uncertainty of outcome indicators was generally high; five out of seven had less than 10 events per centre. Conclusions Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators. Trial registration The core study was registered with ClinicalTrials.gov, number NCT02210221 , registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).

中文翻译：

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欧洲重症监护病房创伤性脑损伤患者的质量指标：一项 CENTER-TBI 研究

背景 本研究的目的是验证先前发布的基于共识的质量指标集，用于管理欧洲重症监护病房 (ICU) 的创伤性脑损伤 (TBI) 患者，并研究其在质量测量和改进方面的潜力。方法 我们的分析基于 2014 年至 2018 年间入住 54 个 ICU 的 2006 名成年患者，这些患者参加了 CENTER-TBI 研究。指标得分计算为结构和过程指标的遵守百分比以及结果指标的事件率或中位数。可行性通过变量的完整性来量化。可区分性由中心间的变异决定，用随机效应回归模型估计，根据病例组合的严重程度进行调整，并通过中位优势比 (MOR) 量化。结果指标的统计不确定性由每个中心的事件数中位数确定，截止值为 10。结果 从 CENTER-TBI 数据库中可以计算出总共 26/42 个指标。大多数质量指标被证明是可行的，完成度超过 70%。大多数质量指标的依从性都不理想，结构和过程指标的依从性为 26% 至 93% 和 20% 至 99%。在七个过程指标和五个结果指标中发现了显着 (p < 0.001) 中心之间的差异，MOR 的范围从 1.51 到 4.14。结果指标的统计不确定性普遍较高；七个中的五个每个中心的事件少于 10 个。结论 总体而言，九个结构，五个过程，但没有一项结果指标显示出改善 ICU 中 TBI 患者质量的潜力。未来的研究应侧重于实施工作和质量指标的持续重新评估。试验注册 核心研究在 ClinicalTrials.gov 注册，编号 NCT02210221，于 2014 年 8 月 6 日注册，资源识别门户（RRID：SCR_015582）。