ReviewThe value of trauma registries
Introduction
Injuries are the most frequent cause of death under the age of 45 in most high-income countries,88, 91 as well as a major financial burden.20, 21, 91 In low-income countries, the societal costs of injury are even more alarming—projections show that road traffic deaths will increase by 83% between 2000 and 2020 in countries undergoing industrialisation.71 While injury prevention is certainly the most cost-effective approach to this problem, the medical profession also has an obligation to monitor the care delivered to victims of trauma.
The idea of categorising injury types, treatments, and expected outcomes can be traced back to the ancient Egyptians,52 and armies over the centuries have studied the wounds of soldiers in order to design better protective equipment and to improve the management of diseases and injuries. Indeed, the accomplishments of Florence Nightingale were achieved by her effective use of such statistics as well as her personal dedication to individual patients.18
The modern era of trauma registries appears to have begun with the computerised trauma database implemented in Cook County Hospital, Chicago in 1969, leading to the Illinois State trauma registry in 1971.8 The consolidation of hospital-based registries into regional and national databases, along with the increasing capacity of computers and statistical methods for their analysis, has led to the rapid expansion of this potential resource to study the adverse effects of injury.
The purpose of this review is to define the structure and purpose of contemporary trauma registries, acknowledge their limitations, and discuss possible ways to make them more useful. In particular, we hope to demonstrate that trauma registries combined from multiple institutions can add value beyond readily available hospital administrative data.
Section snippets
What are trauma registries?
Trauma registries are databases designed to document the acute phase of hospital care delivered to victims of trauma. Patients are included in the database according to specific inclusion criteria, usually based on a definition using the international classification of diseases (ICD). Trauma registries generally include information on patient demographics, the circumstances surrounding injury, pre-hospital care and transport, emergency department and in-hospital interventions received, anatomic
Quality improvement
Originally, trauma registries were designed as a quality improvement tool for individual hospitals treating injured patients, but were subsequently implemented as part of integrated trauma systems. Registries are continually used to support such systems in accreditation, verification and designation processes. Studies demonstrating the decrease in trauma mortality following the introduction of integrated trauma systems have provided indirect evidence of the value of trauma registries.41, 49, 50
Data quality
In order to maximise the quality and integrity of data, trauma registries must be governed by a central organisation responsible for data aggregation, validation37 and analysis. Data validation is essential to ensure the quality of registry data but requires a thorough data cleaning process, follow-up and correction of data problems, and studies of intra- and inter-coder agreement. A steering committee composed of representatives from key stakeholders should oversee procedures and make sure
The future of trauma registries
Judging by the present trend, the use of trauma registries for research will continue to increase, particularly as national trauma registries become freely available to researchers worldwide.68 If we are to enhance their value, efforts should be made to improve the quality of data, the efficiency of data collection and the information content of trauma registries.
Many of the problems associated with trauma registries have also been experienced by colleagues involved with cancer, cardiac
Conclusions
Trauma registries require significant financial investment and the dedication of all those involved in their upkeep. To be worthwhile, they must continually be used to improve our understanding of the mechanisms of trauma and the care delivered to victims of trauma. Efforts must also be made to ensure high-data quality and acceptable population coverage. We have shown that trauma registries are already being used to describe injury epidemiology and suggest prevention strategies, to evaluate the
Conflict of interest statement
David E. Clark is chairman of the National Trauma Data Bank Subcommittee for the American College of Surgeons Committee on Trauma. Neither of the authors have any other conflicts of interest to declare.
References (102)
The emerging science of functional assessment: our tool for outcomes analysis
Arch Phys Med Rehabil
(1998)- et al.
The influence of demographic factors on seatbelt use by adults injured in motor vehicle crashes
Accid Anal Prev
(2001) - et al.
Progress toward a new injury severity characterization: severity profiles
Comput Biol Med
(1988) - et al.
Trauma scoring systems: a review
J Am Coll Surg
(1999) The national pediatric trauma registry: a legacy of commitment to control of childhood injury
Semin Pediatr Surg
(2004)- et al.
A decade to the Israel national trauma registry
Isr Med Assoc J
(2007) - et al.
Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models
BMJ
(2007) - et al.
Clinical trials: are they a good buy?
J Clin Oncol
(2001) - et al.
Paying the price of excluding patients from a trauma registry
J Trauma
(2006) - et al.
Improving the TRISS methodology by restructuring age categories and adding comorbidities
J Trauma
(2004)
A new approach to outcome prediction in trauma: a comparison with the TRISS model
J Trauma
Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score
J Trauma
Trauma registry. New computer method for multifactorial evaluation of a major health problem
JAMA
Access to trauma centers in the United States
JAMA
Developing Australia's first statewide trauma registry: what are the lessons?
Aust NZ J Surg
The trauma registry as a statewide quality improvement tool
J Trauma
Limitations of the TRISS method for interhospital comparisons: a multihospital study
J Trauma
A new characterization of injury severity
J Trauma
Improved predictions from a severity characterization of trauma (ASCOT) over trauma and injury severity score (TRISS): results of an independent evaluation
J Trauma
The Major Trauma Outcome Study: establishing national norms for trauma care
J Trauma
Epidemiology and short-term outcomes of injured medicare patients
J Am Geriatr Soc
Predicting hospital mortality, length of stay, and transfer to long-term care for injured patients
J Trauma
Florence Nightingale
Sci Am
Linking data from national trauma and rehabilitation registries
J Trauma
Cost of injury
Incidence and economic burden of injuries in the United States
A state trauma registry as a tool for occupational injury surveillance
J Occup Environ Med
Is the revised trauma score still useful?
Aust NZ J Surg
Routine follow up of major trauma patients from trauma registries: what are the outcomes?
J Trauma
TRISS: does it get better than this?
Acad Emerg Med
Choosing outcome assessment instruments for trauma registries
Acad Emerg Med
Cargo areas of pickup trucks: an avoidable mechanism for neurological injuries in children
J Neurosurg
Judging trauma center quality: does it depend on the choice of outcomes?
J Trauma
Characteristics and conviction rates of injured alcohol-impaired drivers admitted to a tertiary care Canadian trauma centre
Clin Invest Med
The outcome for children with blunt trauma is best at a pediatric trauma center
J Pediatr Surg
Factors associated with back pain after physical injury: a survey of consecutive major trauma patients
Spine
Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury
J Trauma
Automatic prediction of trauma registry procedure codes from emergency room dictations
Medinfo
A chi-square automatic interaction detection (CHAID) analysis of factors determining trauma outcomes
J Trauma
Trauma registry data validation: essential for quality trauma care
J Trauma
Screening and intervention for alcohol problems among patients admitted following unintentional injury: a missed opportunity?
N Z Med J
Five-year outcome after mild head injury: a prospective controlled study
Acta Neurol Scand
Are restrained children under 15 years of age in cars as effectively protected as adults?
Arch Dis Child
Systematic review of trauma system effectiveness based on registry comparisons
J Trauma
The burden of noncompliance with seat belt use on a trauma center
J Trauma
Incorporating recent advances to make the TRISS approach universally available
J Trauma
Can adult trauma surgeons care for injured children?
J Trauma
Standards for statistical models used for public reporting of health outcomes: an American Heart Association scientific statement from the Quality of Care and Outcomes Research Interdisciplinary Writing Group: cosponsored by the Council on Epidemiology and Prevention and the Stroke Council. Endorsed by the American College of Cardiology Foundation
Circulation
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