Retrospective versus concurrent review on the quality of care of pediatric trauma patients

To compare and contrast retrospective versus concurrent quality of care review processes in a Level I Trauma Center, we conducted a retrospective chart review of all pediatric trauma admissions in 1990 in = 113) and compared it to the concurrent trauma quality assurance program for the same time period. Twenty-four percent (24%) of the patients reviewed in the retrospective study were identified by Alters and reviewed through the concurrent process. In both the retrospective and concurrent review process problems in medical care problems, documentation, social and preventive elements of the case, and overall assessment of the patients’ care were described. Overall, we found less than 50% agreement between the two reviews. The retrospective review identified medical care issues in 64% of cases, compared with a 44% error rate noted in the concurrent review (P < 0.07). Reviewers were more likely to note the absence of appropriate documentation, and overall assessment of the patients’ care in the retrospective process (P < 0.0001). The retrospective review also highlighted issues related to the prevention of the injury and the patients’ social situation, which were not considered by the concurrent review. Overall, we found the concurrent review appropriate for case by case medical management, while the retrospective review was relevant to a systems approach to the care of the injured child. To obtain a complete picture of the care of injured children, we recommend 1) a portion of charts be reviewed retrospectively in addition to ongoing concurrent review; or 2) the concurrent review add filters that are specific to pediatric issues and overall system issues.