Elsevier

Injury

Volume 46, Issue 2, February 2015, Pages 201-206
Injury

Trauma registry methodology: A survey of trauma registry custodians to determine current approaches

https://doi.org/10.1016/j.injury.2014.09.010Get rights and content

Abstract

Introduction

The global burden of injury is enormous, especially in developing countries. Trauma systems in highincome countries have reduced mortality and disability. An important component of trauma quality improvement programmes is the trauma registry which monitors the epidemiology, processes and outcomes of trauma care. There is a severe deficit of trauma registries in developing countries and there are few resources to support the development of trauma registries. Specifically, publicly available information of trauma registry methodology in developed trauma registries is sparse. The aim of this study was to describe and compare trauma registries globally.

Methods

A survey of trauma registry custodians was conducted. Purposive sampling was used to select trauma registries following a structured review of the literature. Registries for which there were at least two included abstracts over the five-year period were defined as active and selected. Following piloting and revision, a detailed survey covering physical and human resources, administration and methodology was distributed. The survey responses were analysed; single hospital and multi-hospital registries were compared.

Results

Eighty-four registries were emailed the survey. Sixty-five trauma registries participated, giving a response rate of 77%. Of the 65 participating registries, 40 were single hospital registries and 25 were multi-hospital registries. Fifteen countries were represented; more than half of the participating registries were based in the USA. There was considerable variation in resourcing and methodology between registries. A trauma registry most commonly had at least three staff, reported to both the hospital and government, included more than 1000 cases annually, listed admission, death and transfer amongst inclusion criteria, mandated collection of more than 100 data elements, used AIS Version 2005 (2008 update) and used age, the Glasgow Coma Scale and the Injury Severity Score for injury severity adjustment.

Conclusion

Whilst some characteristics were common across many trauma registries, the resourcing and methodology varied markedly. The common features identified may serve as a guide to those looking to establish a trauma registry. However much remains to be done for trauma registries to determine the best standardised approach.

Introduction

The global burden of injury is enormous [1]. The introduction of systems of trauma care in high-income countries has led to a reduction in mortality and disability [2], [3], [4]. However, in low- and middle-income countries (LMICs), which suffer the greatest burden of injury, access to quality trauma care is severely limited [5], [6]. To reduce this disparity, the World Health Organization (WHO) first published guidelines for implementing “essential trauma care” and subsequently published a manual specifically focusing upon trauma care quality improvement [5], [6]. One of the five pillars of the United Nations’ “Global Plan” for the current “Decade of Action for Road Safety 2011–2020” is “Post crash response”, for which Activity 2 was “Develop hospital trauma care systems and evaluate the quality of care through the implementation of good practices on trauma care systems and quality assurance” and Activity 7 was “Encourage research and development into improving post crash response” [7]. An essential platform to enable quality improvement in trauma care systems is the trauma registry.

A trauma registry is a database which documents the epidemiology, processes and outcomes of trauma care. Trauma registries, measuring the impact of injury and quality of care, have been a key component of developed trauma systems for decades. They have been critical for driving quality improvement and demonstrating the benefits, including mortality and disability reduction, of these systems of care [2], [3], [4], [8], [9]. Like systems of trauma care, there is a great disparity in the number of trauma registries between developed and developing countries. Most trauma registries are based in the USA, Australia, Canada, Germany and the UK; there are far fewer trauma registries across Asia, South America and Africa [10], [11].

To redress this imbalance and facilitate trauma registry development globally, there are few resources beyond the WHO guidelines [10], [11]. There is no single resource available that provides comprehensive insight into the experience across trauma registries, regardless of the level of the source country's development. Although using the considerable experience of the well-established trauma registries in developed countries would be a valuable exercise for those looking to establish trauma registries in developing countries, there are currently several challenges to achieving this. Even amongst mature trauma registries, there is no clear consensus or standardisation of best methods [10], [11]. Furthermore, the published details of trauma registry methodology in developed trauma registries remain incomplete. There has, to date, been little comparison and summary of trauma registry methodology from well-established trauma registries. One relatively recent study relied primarily on web-based resources with an inconsistent input from trauma registry custodians; the key foci of attention in the study were the inclusion criteria and patient-level outcomes in regional trauma registries [12]. More detailed information on registry resources, governance and data methodology, including variable selection, injury severity adjustment, missing data methods and analyses performed, would facilitate the application of optimal and standardised approaches amongst developed trauma registries and, most importantly, provide a resource for developing trauma systems to best inform trauma registry development and methodology. Such detailed information on trauma registries is not currently available.

Section snippets

Aim

The aim of this study was to describe and compare trauma registries globally.

Design

This was a cross-sectional observational study, using a survey of trauma registry custodians.

Population and sampling

Purposive sampling was used to select trauma registries. A structured review of the literature was performed. Relevant abstracts for the five-year period 2008–2012 were identified by searching MEDLINE database on 5 May 2013. There were no language restrictions placed on the search. Keywords employed in the search were: “trauma registry”, “trauma registries”, “trauma database*”, “trauma databank*”,

Results

The search strategy returned 1220 articles. Application of the pre-defined inclusion criteria led to the identification of 867 abstracts from 305 trauma registries. 106 registries had two or more publications in the targeted five-year period and were selected for consideration for the study sample of active trauma registries, pending confirmation of contact details. Contact details were confirmed for 84 of the active trauma registries, all of whom received the survey. Sixty-five trauma

Discussion

This is the first published survey of trauma registry custodians. Participants have been drawn from a large proportion of known active registries and from a variety of geographical locations, globally. The study covers a broad range of questions and provides a detailed picture of the resources and processes of trauma registries. This is the most extensive examination of trauma registry practices to date.

Previous studies utilising peer-reviewed medical literature and publicly available trauma

Limitations

Despite the very healthy response rate and resultant representativeness of this study, survey methodology does have its limitations. The purposive sampling was based on being published in the medical peer-reviewed literature; developing countries are likely to be under-represented, as are registries based in institutions with a less academic focus. In the absence of a comprehensive and accessible database of trauma registries globally (and the contact details of their key staff), this sampling

Conclusion

Trauma registries vary considerably with regard to physical resources, human resources and processes. The features which are common to the majority of registries may guide those seeking to establish a registry in their own setting. There is still much work to be done to standardise trauma registries and allow for benchmarking of trauma systems. Resource disparity may demand a two-tiered approach. Firstly, to establish a trauma registry in a low-resourced setting, a set of minimum or essential

Conflict of interest

None declared.

Acknowledgements

There were no sources of funding for this study. The authors which to acknowledge those who participated in either the pilot or study phases of the survey.

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