Global trauma registry mapping: A scoping review
Introduction
Injury is a major global public health problem.1, 2, 3, 4, 5 Each year, 5.8 million people die from injury, and many more are disabled. It is the leading cause of death of men and women under the age of 45, and is responsible for more productive years of life lost than heart disease and cancer combined. The burden is especially high in low- and middle-income countries (LMICs) where more than 90% of the world's deaths from injuries occur.1, 2, 3, 4, 5
In 2004, the World Health Organization (WHO) published Guidelines for Essential Trauma Care, seeking to “reduce disparities in injury outcome between LMICs and high-income countries (HICs) by establishing achievable and affordable standards for injury care worldwide”.2 Many HICs have significantly lowered trauma mortality rates by improving the organisation of, and planning for, trauma care through the implementation of trauma systems that address all aspects of care – from the prehospital setting, to initial resuscitation in the hospital, to longer term definitive care.6, 7, 8, 9, 10, 11, 12, 13, 14 In Australia, for example, Cameron et al. demonstrated that the introduction of a statewide trauma system was associated with a significant reduction in risk-adjusted mortality.6 Comparing countries with and without trauma systems, Mock et al. showed that people with life-threatening but potentially treatable injuries are up to six times more likely to die in a country with no organised trauma system than in one with an organised, resourced trauma system.7 Such inclusive systems of trauma care should be regarded as a minimum standard for health jurisdictions. But trauma system development remains basic in many LMICs.
In 2009, to further strengthen the quality of trauma care globally, the WHO published Guidelines for Trauma Quality Improvement Programmes.1 The efficiency of Trauma Quality Improvement (TQI) activities is optimal where there is access to a trauma registry collecting trauma-specific data.1 A trauma registry is broadly defined as a dedicated data repository for trauma patients.1 In one of the few reviews conducted on the topic, Moore and Clark further defined trauma registries as “databases that document acute care delivered to patients hospitalised with injuries…designed to provide information that can be used to improve the efficiency and quality of trauma care”.15 Specifically, trauma registries are used to describe injury epidemiology, track quality indicators, benchmark trauma care and advocate injury prevention policy; they are integral to trauma quality improvement programmes (TQIPs).1, 15, 16
Trauma registries have been in existence for more than three decades in HICs allowing local, national and international benchmarking and performance improvement.15, 17, 18, 19 They are now considered to be an essential component of mature trauma systems.15, 17, 18, 19 Whilst many LMICs have recognised the need for trauma system development, including the establishment of trauma registries to monitor these systems, their existence in LMICs remains sporadic at best, and to date, there has been no published account of where trauma registries exist.1, 2, 15
The primary objective of this review was to determine the current distribution of active trauma registries, globally, using published literature and publicly available resources. A secondary objective was to identify a selection of established trauma registries and provide a preliminary comparison of registry methodology between developed and developing trauma systems.
Section snippets
Materials and methods
A structured literature review was performed. Relevant abstracts were identified by searching the following databases on 25 January, 2011: Medline, EMBASE and CINAHL. Searches were restricted to the two year period from 1 January 2009 to 31 December 2010. The period of two years was chosen to represent current registry activity through publication in the medical literature. There were no language restrictions. Key words employed in the search were: “trauma registry”, “trauma registries”,
Results
The literature search identified 640 abstracts of which 571 referred to a trauma registry (see Supplementary File 1).
The sub-type of trauma registry was identifiable in 552 articles and is described in Table 1. Most of the articles (436(76%)) described trauma registries which were inclusive of “general” trauma patients regardless of mechanism, type of injury or age. After these, the registries most frequently described in publications were limited to military (36(6%)) or paediatric (35(6%))
Discussion
This structured review of the literature provides a global perspective on the comparative level of trauma registry activity across countries at different levels of development. It demonstrates that relatively few effective trauma registries exist in developing countries. Where trauma registries do exist in developing countries, their methods tend to vary markedly from counterparts in developed trauma systems. Those countries that carry a disproportionately high level of the burden of injury are
Conclusion
Despite carrying the greatest burden of injury, developing countries are grossly under-represented with respect to trauma registry activity. There is an urgent need for global investment in the capacity of developing countries to monitor trauma system development and improvements in trauma care, and all emergency care, through the co-existence of active context-relevant trauma registries.
Conflict of interest statement
There are no known or perceived conflicts of interest. There were no sources of funding for this study.
References (28)
- et al.
The value of trauma registries
Injury
(2008) - et al.
Guidelines for trauma quality improvement programmes
(2009) - et al.
Guidelines for essential trauma care
(2004) - et al.
World report on road traffic injury prevention
(2004) The injury chartbook. A graphical overview of the global burden of injuries
(2002)- World Health Organization. Global status report on road safety: time for action. Geneva; 2009...
- et al.
A statewide system of trauma care in Victoria: effect on patient survival
Med J Aust
(2008) - et al.
Trauma outcomes in the rural developing world: comparison with an urban level I trauma center
J Trauma
(1993) - et al.
Do designated trauma systems improve outcome?
Curr Opin Crit Care
(2007) - et al.
A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems
J Trauma
(2006)
Inclusive trauma systems: do they improve triage or outcomes of the severely injured?
J Trauma
Assessing effectiveness of a mature trauma system: association of trauma centre presence with lower injury mortality rate
J Trauma
Evaluation of a mature trauma system
Ann Surg
Management deficiencies and death preventability of road traffic fatalities before and after a new trauma care system in Victoria Australia
J Trauma
Cited by (85)
Pediatric trauma mortality in India and the United States: A comparison and risk-adjusted analysis
2023, Journal of Pediatric SurgeryA cohort of pediatric injury patients from a hospital-based trauma registry in Northern Tanzania
2022, African Journal of Emergency MedicineCitation Excerpt :Trauma registries are an efficient way to organize patient data to determine what areas need to be improved, and thus can lead to important quality improvement initiatives that have the potential to impact injury morbidity and mortality [10]. While injury registries for adult populations have become common [11], injury registries specific to children are rarer, and the literature on pediatric trauma epidemiology in LMICs is limited [12]. In this manuscript, we present a cohort of pediatric injury patients enrolled in a prospective pediatric trauma registry at a zonal referral hospital in Northern Tanzania.