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.
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