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Effect of a continuous trauma quality improvement programme on mortality in urban India: a non-randomised controlled trial

Berg, Johanna LU orcid ; David, Siddarth ; Bakhshi, Girish D. ; Basak, Debojit ; Chatterjee, Shamita ; Soni, Kapil Dev ; Ekelund, Ulf LU orcid ; Felländer-Tsai, Li ; Joshipura, Manjul and Khan, Tamal , et al. (2025)
Abstract
Background Trauma is the leading cause of quality-related mortality in low- and middle-income countries, with an estimated two million preventable deaths each year. Although trauma quality improvement programmes have been utilised in high-income countries for more than three decades, there is no high-level evidence of their effect on patient outcomes. We aimed to assess whether implementing a continuous trauma quality improvement programme using audit filters improves mortality among adult trauma patients in urban India.

Methods We conducted a prospective controlled interrupted time-series study across four tertiary hospitals in urban India between 2017 and 2022. Two hospitals implemented a trauma quality improvement programme... (More)
Background Trauma is the leading cause of quality-related mortality in low- and middle-income countries, with an estimated two million preventable deaths each year. Although trauma quality improvement programmes have been utilised in high-income countries for more than three decades, there is no high-level evidence of their effect on patient outcomes. We aimed to assess whether implementing a continuous trauma quality improvement programme using audit filters improves mortality among adult trauma patients in urban India.

Methods We conducted a prospective controlled interrupted time-series study across four tertiary hospitals in urban India between 2017 and 2022. Two hospitals implemented a trauma quality improvement programme after a one-year observation phase (intervention arm); two continued standard care (control arm). Time-series analysis was done using monthly aggregated data with generalised additive models. A difference-in-differences approach was used for secondary analysis. The primary outcome was all-cause in-hospital mortality; the secondary outcome was 30-day mortality.

Findings In total, 10 143 adult trauma patients were included (median age 35 years; 83% men). In-hospital mortality decreased by 11.2% (95% CI –16.0 to –5.5) in the intervention arm, with no evidence of change in the control arm (–0.5%; 95% CI –4.0 to 5.4). Secondary difference-in-differences analysis showed consistent reductions in in-hospital mortality (–12%; 95% CI –16 to –9) and 30-day mortality (–15%; 95% CI –19 to –11). No seasonal or autocorrelation effects were observed. External factors, including the opening of a dedicated trauma centre at one site and the COVID-19 pandemic, may have influenced the results.

Interpretation Trauma quality improvement programmes may improve mortality, particularly in settings with a high number of preventable deaths, and can contribute to reducing the global burden of quality-related mortality. Further research is needed to confirm these results, clarify the mechanisms through which such programmes mediate their effect, and determine how they can be sustained over time. (Less)
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type
Working paper/Preprint
publication status
published
subject
publisher
medRxiv
DOI
10.1101/2024.05.27.24307748
language
English
LU publication?
yes
id
ed9f1512-ed22-4632-81ee-402026765280
date added to LUP
2026-03-04 20:21:46
date last changed
2026-03-05 08:20:53
@misc{ed9f1512-ed22-4632-81ee-402026765280,
  abstract     = {{Background Trauma is the leading cause of quality-related mortality in low- and middle-income countries, with an estimated two million preventable deaths each year. Although trauma quality improvement programmes have been utilised in high-income countries for more than three decades, there is no high-level evidence of their effect on patient outcomes. We aimed to assess whether implementing a continuous trauma quality improvement programme using audit filters improves mortality among adult trauma patients in urban India.<br/><br/>Methods We conducted a prospective controlled interrupted time-series study across four tertiary hospitals in urban India between 2017 and 2022. Two hospitals implemented a trauma quality improvement programme after a one-year observation phase (intervention arm); two continued standard care (control arm). Time-series analysis was done using monthly aggregated data with generalised additive models. A difference-in-differences approach was used for secondary analysis. The primary outcome was all-cause in-hospital mortality; the secondary outcome was 30-day mortality.<br/><br/>Findings In total, 10 143 adult trauma patients were included (median age 35 years; 83% men). In-hospital mortality decreased by 11.2% (95% CI –16.0 to –5.5) in the intervention arm, with no evidence of change in the control arm (–0.5%; 95% CI –4.0 to 5.4). Secondary difference-in-differences analysis showed consistent reductions in in-hospital mortality (–12%; 95% CI –16 to –9) and 30-day mortality (–15%; 95% CI –19 to –11). No seasonal or autocorrelation effects were observed. External factors, including the opening of a dedicated trauma centre at one site and the COVID-19 pandemic, may have influenced the results.<br/><br/>Interpretation Trauma quality improvement programmes may improve mortality, particularly in settings with a high number of preventable deaths, and can contribute to reducing the global burden of quality-related mortality. Further research is needed to confirm these results, clarify the mechanisms through which such programmes mediate their effect, and determine how they can be sustained over time.}},
  author       = {{Berg, Johanna and David, Siddarth and Bakhshi, Girish D. and Basak, Debojit and Chatterjee, Shamita and Soni, Kapil Dev and Ekelund, Ulf and Felländer-Tsai, Li and Joshipura, Manjul and Khan, Tamal and Khajanchi, Monty and L N, Mohan and Mishra, Anurag and Petzold, Max and Rajan, Sendhil and Roy, Nobhojit and Singh, Rajdeep and Gerdin Wärnberg, Martin}},
  language     = {{eng}},
  month        = {{11}},
  note         = {{Preprint}},
  publisher    = {{medRxiv}},
  title        = {{Effect of a continuous trauma quality improvement programme on mortality in urban India: a non-randomised controlled trial}},
  url          = {{http://dx.doi.org/10.1101/2024.05.27.24307748}},
  doi          = {{10.1101/2024.05.27.24307748}},
  year         = {{2025}},
}