Development of the Major Trauma Case review tool

Prof. Kate Curtis1, A/Prof Rebecca Mitchell2, Ms Amy McCarthy1, Mrs Kellie Wilson3, Dr Connie Van1, Ms Belinda Kennedy1, Dr Gary Tall4, Professor Andrew Holland5, Prof Kim Foster1,6, Mr Stuart Dickinson7, A/Prof Tom Stelfox8

1Sydney Nursing School, Coledale, Australia, 2Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University,  Sydney, Australia, 3NSW Institute of Trauma and Injury Management, Sydney, Australia, 4NSW Ambulance, Sydney, Australia, 5Sydney Medical School, The University of Sydney , Sydney, Australia, 6NorthWestern Mental Health & School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Melbourne, Australia, 7Human Risk Solutions, Melbourne, Australia, 8Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, Calgary, Canada

As many as half of all patients with major traumatic injuries do not receive the recommended care, with variance in preventable mortality reported across the globe.  The World Health Organisation states the need for a comprehensive process for monitoring and reviewing patient care, central to which is a consistent peer-review process that includes trauma system safety and human factors.  There is no published, evidence-informed standardised tool that considers these factors for trauma case peer-review.

Aim: To develop and validate a trauma case review tool to facilitate clinical review of paediatric trauma patient care in extracting information to facilitate monitoring, inform change and enable loop closure.

Methods: Development  was multi-faceted, beginning with a review of the  literature. Data were extracted from the literature to inform iterative tool development using a consensus approach.  A validated human factors framework was incorporated to determine environmental, organisational and individual characteristics which influence behaviour at work in a way which can affect health and safety. This enables a greater focus on why the event occurred, and removes focus from the individual. Inter-rater agreement was assessed.

Results: The final trauma case review tool contained ten sections, including patient factors (such as pre-existing conditions), presenting problem, a timeline of events, factors contributing to the care delivery problem (including equipment, work environment, staff action, organizational factors), positive aspects of care and the outcome of panel discussion. The tool considered the effectiveness of trauma system (pre-hospital and in-hospital). After refinement, the inter-rater reliability of the human factors and outcome components of the tool improved with an average 86% agreement between raters.

Conclusions: This research developed an evidence-informed tool for use in paediatric trauma case review that considers both system safety and human factors to facilitate clinical review of trauma patient care. Validation is required in the adult population.


Kate Curtis has been an Emergency Nurse since 1994 and is Professor at Sydney Nursing School. She is an honorary professorial fellow at the George Institute for Global Health, a Fellow of the College of Emergency Nursing Australasia. Kate’s translational research program continues to focus on improving the way we deliver care to patients and their families