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Sonshine DB, Shantz J, Kumah-Ametepey R, Coughlin RR, Gosselin RA. The implementation of a pilot femur fracture registry at Komfo Anokye Teaching Hospital: an analysis of data quality and barriers to collaborative capacity-building. World J Surg 2014; 37:1506-12. [PMID: 22851146 DOI: 10.1007/s00268-012-1726-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Trauma registries are essential for injury surveillance and recognition of the burden of musculoskeletal injury in low- and middle-income countries (LMICs). The purpose of this study was to pilot a femur fracture registry at Komfo Anokye Teaching Hospital (KATH) to assess data quality and determine the barriers to research partnering in LMICs. METHODS All patients admitted to KATH with a fracture of the femur, or Arbeitsgemeinschaft für Osteosynthesefragen (AO) class 31, 32, 33, were entered into a locally designed, electronic femur fracture database. Patients' characteristics and data quality were assessed by using descriptive statistics. Orthopedic trauma research barriers and opportunities were identified from key informants at the research site and supporting site. RESULTS Ninety-six femur fracture patients were enrolled into the registry over a 5-week period. The majority of patients resided in the Ashanti region surrounding the hospital (78 %). Most participants were involved in a road traffic crash (58 %) and physiologically stable with a Cape Triage Score of yellow upon admission (84 %). AO class 32 femur fractures represented the majority of femur fractures (78 %). Median times from injury to admission, admission to surgery, and surgery to discharge were 0, 5, and 10 days, respectively. Data quality analysis showed that data collected at admission had higher rates of completion in the database relative to data collected at various follow-up time points. CONCLUSIONS Data and data quality analyses highlighted characteristics of femur fracture patients presenting to KATH as well as the technological, administrative support, and hospital systems-based challenges of longitudinal data collection in LMICs.
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Affiliation(s)
- Daniel B Sonshine
- Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Engel DC. Standardizing data collection in severe trauma: call for linking up. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:105. [PMID: 22277684 PMCID: PMC3396219 DOI: 10.1186/cc10561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Standardization of data collection in severely injured trauma patients in order to find the best performance and practice has been an issue for more than 20 years. The incidence of trauma has decreased and outcomes have improved over the past decades. Trauma still remains an important public health problem, however, and is listed by the World Health Organization as a leading cause of death and disability. Ringdal and colleagues prove the feasibility on a basic level in their prospective, intercontinental study showing the results of the Utstein Trauma Template. In-depth analysis is currently only partially possible. The future of standardizing data collection in trauma looks bright. However, bridging and cross-linking is necessary to a great extent in the future.
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Affiliation(s)
- Doortje C Engel
- Department of Neurosurgery, Cantonal Hospital of St Gallen, Rorschacherstrasse 95, CH-9007 St Gallen, Switzerland.
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Mitchell R, Williamson A, Curtis K. What is the potential of trauma registry data to be used for road traffic injury surveillance and informing road safety policy? JOURNAL OF SAFETY RESEARCH 2011; 42:345-350. [PMID: 22093568 DOI: 10.1016/j.jsr.2011.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 06/28/2011] [Accepted: 06/29/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Information from hospital trauma registries is increasingly being used to support injury surveillance efforts. This research examines the potential of using trauma registry data for road traffic injury surveillance for different types of road users in terms of both the information collected and how representative trauma data are compared to two population-based road traffic injury data collections. METHODS The three data collections were assessed against recommended variables to be collected for injury surveillance purposes and the representativeness of the distribution of road traffic-related injury data from the trauma registry was compared to hospital admission and road traffic authority data collections. RESULTS Data from the trauma registry was largely not representative of the distribution of age groups or activities compared to the two population-based collections, but was representative for gender for some road user groups to at least one population-based data collection. CONCLUSIONS Trauma data could be used to supplement information from population-based data collections to inform road safety efforts. IMPACT ON INDUSTRY Road safety policy makers should be aware of the potential and the limitations of using trauma registry data for road traffic injury surveillance.
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Affiliation(s)
- Rebecca Mitchell
- NSW Injury Risk Management Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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A comparison of major trauma patients transported to trauma centres vs. non-trauma centres in metropolitan Perth. Resuscitation 2011; 82:560-3. [PMID: 21334800 DOI: 10.1016/j.resuscitation.2011.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 01/18/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Some major trauma patients in metropolitan Perth (area 5000 km(2)) are initially transported to a secondary hospital (non-trauma centre), rather than directly to a tertiary hospital (trauma centre). They are subsequently transferred to a tertiary hospital. We compared outcomes from these different systems of care. METHODS Major trauma (Injury Severity Score, ISS>15) data from the Trauma Registries, 1 July 1997-30 June 2006. Two groups were studied: group 1 (metropolitan major trauma transported directly to a tertiary hospital) and group 2 (metropolitan major trauma transported initially to a secondary hospital and then to a tertiary hospital). The primary endpoint was death. RESULTS Group 1 (n = 2005) and group 2 (n = 1078) mean age (43.9 ± 24.3 yrs vs. 39.1 ± 24.3 yrs, p < 0.0001) both with a median ISS = 24 (p = 0.084). Group 2 had significantly more head/neck injuries (p < 0.0001) and significantly less thoracic, abdominal and pelvis/extremities injuries (p < 0.0001). There were also a significantly greater total number of regions injured in group 1 vs. group 2 (p < 0.0001). Mean times to definitive care were 59 min vs. 4.5h, respectively (p < 0.0001). After adjusting for age, ISS, RTS, total regions injured and time, the OR for death in group 2 was 0.99 (95% CI 0.58-1.68). CONCLUSION There is an equivalent risk of major trauma death in these two systems of care. In our metropolitan area, we were unable to demonstrate a mortality benefit associated with time.
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Ringdal KG, Coats TJ, Lefering R, Di Bartolomeo S, Steen PA, Røise O, Handolin L, Lossius HM. The Utstein template for uniform reporting of data following major trauma: a joint revision by SCANTEM, TARN, DGU-TR and RITG. Scand J Trauma Resusc Emerg Med 2008; 16:7. [PMID: 18957069 PMCID: PMC2568949 DOI: 10.1186/1757-7241-16-7] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 08/28/2008] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In 1999, an Utstein Template for Uniform Reporting of Data following Major Trauma was published. Few papers have since been published based on that template, reflecting a lack of international consensus on its feasibility and use. The aim of the present revision was to further develop the Utstein Template, particularly with a major reduction in the number of core data variables and the addition of more precise definitions of data variables. In addition, we wanted to define a set of inclusion and exclusion criteria that will facilitate uniform comparison of trauma cases. METHODS Over a ten-month period, selected experts from major European trauma registries and organisations carried out an Utstein consensus process based on a modified nominal group technique. RESULTS The expert panel concluded that a New Injury Severity Score > 15 should be used as a single inclusion criterion, and five exclusion criteria were also selected. Thirty-five precisely defined core data variables were agreed upon, with further division into core data for Predictive models, System Characteristic Descriptors and for Process Mapping. CONCLUSION Through a structured consensus process, the Utstein Template for Uniform Reporting of Data following Major Trauma has been revised. This revision will enhance national and international comparisons of trauma systems, and will form the basis for improved prediction models in trauma care.
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Affiliation(s)
- Kjetil G Ringdal
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Faculty of Medicine, Faculty Division Ullevål University Hospital, University of Oslo, Norway
| | - Timothy J Coats
- Academic Unit of Emergency Medicine, Leicester University, UK
| | - Rolf Lefering
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne-Merheim Medical Centre, Cologne, Germany
| | - Stefano Di Bartolomeo
- Unit of Hygiene and Epidemiology, DPMSC, School of Medicine, University of Udine, Italy
| | - Petter Andreas Steen
- Faculty of Medicine, Faculty Division Ullevål University Hospital, University of Oslo, Norway
| | - Olav Røise
- Orthopaedic Centre, Ullevål University Hospital, Oslo, Norway
| | - Lauri Handolin
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Finland
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Nwomeh BC, Lowell W, Kable R, Haley K, Ameh EA. History and development of trauma registry: lessons from developed to developing countries. World J Emerg Surg 2006; 1:32. [PMID: 17076896 PMCID: PMC1635421 DOI: 10.1186/1749-7922-1-32] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 10/31/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A trauma registry is an integral component of modern comprehensive trauma care systems. Trauma registries have not been established in most developing countries, and where they exist are often rudimentary and incomplete. This review describes the role of trauma registries in the care of the injured, and discusses how lessons from developed countries can be applied toward their design and implementation in developing countries. METHODS A detailed review of English-language articles on trauma registry was performed using MEDLINE and CINAHL. In addition, relevant articles from non-indexed journals were identified with Google Scholar. RESULTS The history and development of trauma registries and their role in modern trauma care are discussed. Drawing from past and current experience, guidelines for the design and implementation of trauma registries are given, with emphasis on technical and logistic factors peculiar to developing countries. CONCLUSION Improvement in trauma care depends on the establishment of functioning trauma care systems, of which a trauma registry is a crucial component. Hospitals and governments in developing countries should be encouraged to establish trauma registries using proven cost-effective strategies.
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Affiliation(s)
- Benedict C Nwomeh
- The Department of Pediatric Surgery, Columbus Children's Hospital, The Ohio State University College of Medicine & Public Health, Columbus, OH, USA
| | - Wendi Lowell
- The Department of Pediatric Surgery, Columbus Children's Hospital, The Ohio State University College of Medicine & Public Health, Columbus, OH, USA
| | - Renae Kable
- The Trauma Program, Columbus Children's Hospital, Columbus, OH, USA
| | - Kathy Haley
- The Trauma Program, Columbus Children's Hospital, Columbus, OH, USA
| | - Emmanuel A Ameh
- Division of Pediatric Surgery, Department of Surgery, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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Abstract
Disability and handicap outcome measures are fundamental components of trauma system evaluation. These outcomes are described for survivors of major trauma, attended by the HEMS, London system. Together with measures of injury severity, three functional instruments (Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS) and return to pre-injury work status (RTW)) were used to measure outcome in 201 trauma patients. By 12 months post injury 84.1% of cases were independent in Motor FIM, 88.1% in Cognitive FIM, 79.1% had good outcomes in GOS (grades 4 and 5) and 69.2% had returned to work. The functional measures showed a statistically significant relationship with minor and major and trauma (ISS < 16 and > or = 16): FIM (motor p < 0.002; cognitive p < 0.0003), GOS (p < 0.002) and RTW (p < 0.002). Division according to severity of principal injury confirmed the greatest disability and handicap resulted from the severest injuries (AIS 4-5): 68.9% achieved independence in Motor FIM, 73% in Cognitive FIM and only 40% returned to work. When grouped according to body region of principal injury, neurological injury, particularly severe injury (AIS 4-5) to head and spinal cord regions showed the poorest outcomes. FIM, GOS and RTW are recommended as standard indicators of disability and handicap for trauma registries and outcome studies.
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Affiliation(s)
- J A Baldry Currens
- Academic Unit of Accident and Emergency, St Bartholomew's and The Royal London School of Medicine and Dentistry, UK.
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Sidhu S, Sugrue M, Bauman A, Sloane D, Deane S. Is penetrating injury on the increase in south-western Sydney? THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:535-9. [PMID: 8712987 DOI: 10.1111/j.1445-2197.1996.tb00804.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few Australian studies describe the epidemiology of penetrating trauma. This study describes the incidence and demographic features of penetrating injuries with emphasis on trends and severity analysis. METHODS Case analysis was performed utilizing data from the Liverpool Hospital Trauma Registry (1989-94), NSW Department of Health Hospital Separations (1991-93), and the NSW Bureau of Crime Statistics (1991-93) with reference to the Liverpool and Fairfield Local Government Areas (LGA). RESULTS The Trauma Registry revealed 251 of penetrating trauma. The median age was 26 years (interquartile range 21-33). Ninety-one per cent of the victims were male. Fourteen per cent of patients had an Injury Severity Score (ISS) > 15. Sixty-five per cent of cases were stab injuries and 20% gunshot injuries with the abdomen being the most commonly injured site. Twenty-one per cent of patients underwent laparotomy, 1.6% thoracotomy and 1.2% thoracotomy and laparatomy. There were 10 (4%) deaths. Trends in incidence of penetrating trauma and violent crime involving weapons were analysed. Static trends were observed for the annual incidence of penetrating trauma from the Liverpool Hospital Trauma Registry. Separations for penetrating trauma from Liverpool and Fairfield hospitals showed a slightly increasing trend. Violent crimes involving weapons in the Liverpool and Fairfield LGA showed a static trend. Nevertheless, separations for penetrating trauma and rates of violent crimes involving weapons were higher in south-western Sydney than metropolitan Sydney or NSW. Eight per cent of the LGA population are Vietnamese but this study identified 16% of victims as being Vietnamese. CONCLUSIONS This study found no significant increase in penetrating trauma or violent crime predisposing to penetrating injury in south-western Sydney.
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Affiliation(s)
- S Sidhu
- Trauma Department, Liverpool Hospital, New South Wales, Australia
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Abstract
Audit is the evaluation of patient care. The care of the injured patient commences at the accident scene and involves prehospital triage and management, emergency hospital assessment and resuscitation, diagnostic and therapeutic interventions, operative surgery, intensive care unit management, acute hospital care and rehabilitation. Audit assesses the delivery of trauma care and clinical management and through identification of inadequacies facilitates the introduction of appropriate improvements. Both the American National Academy of Sciences--National Research Council and the Australian National Health & Medical Research Council have recommended the establishment of an audit process to evaluate the quality of trauma management and to obtain quality assurance. They have advised that this process would be assisted by the development of regional trauma registries and a uniform approach to the grading of injuries. Reduction in the preventable death rate, frequency of complications and duration of hospitalization has followed audits as a result of changes in the organization and quality of trauma care. In the United States, for example, the preventable death rate after injury was reduced from 35 to 15% in Orange County, California and from 14 to 3% in San Diego County, California. Studies from Great Britain. The Netherlands, Canada, Australia and elsewhere have further supported the view that trauma audit modifies practice leading to reductions in mortality and morbidity.
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Affiliation(s)
- F T McDermott
- Department of Surgery, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
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Abstract
The increasing importance of computer-stored databases for clinical research prompted a historical review of their evolution over the past three decades. The special problems associated with the computer processing of clinical research data were reviewed, and the various types of clinical research registers and databases were described.
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Affiliation(s)
- M F Collen
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94611
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