Performance of individual audit filters in predicting opportunities for improvement in adult trauma patients.

Background: Trauma audit filters, based on standards of care, serve as quality indicators and screening tools for patient cases to be assessed at interdisciplinary morbidity and mortality conferences. These conferences aim to identify potential opportunities for improvement in the care of trauma patients. This study aimed to determine the performance of individual audit filters in predicting opportunities for improvement and their relevance as screening tools for morbidity and mortality conferences. Methods: We conducted a single-center registry-based retrospective cohort study based on registered data collected between 2013 and 2022 from the Karolinska University Hospital in Sweden. Performance was measured using sensitivity, specificity, positive predictive value, negative predictive value, and Matthews correlation coefficient for 10 audit filters used at the Karolinska University Hospital. Results: Our analysis included 8309 patients. Audit filters demonstrated inconsistent agreement with opportunities for improvement with a Matthews correlation coefficient ranging from -0.088 (95% CI -0.129 to -0.044) for "Injury Severity Score >15 and no team activation" to 0.092 (95% CI 0.058 to 0.126) for "> 60 min until first major intervention." The Matthews correlation coefficient for all audit filters combined was 0.118 (95% CI 0.104 to 0.131). Conclusion: No individual audit filter or combination thereof performed well in predicting opportunities for improvement, which suggests that the current method of screening for morbidity and mortality conferences should be revisited. Level of evidence: Level III, prognostic/epidemiological.