Elsevier

Injury

Volume 43, Issue 7, July 2012, Pages 1148-1153
Injury

Global trauma registry mapping: A scoping review

https://doi.org/10.1016/j.injury.2012.03.003Get rights and content

Abstract

Background

The burden of injury is very high in developing countries. Trauma systems reduce mortality; the trauma registry is a key driver of improvements in trauma care. Developing countries have begun to develop trauma systems but the level of local trauma registry activity is unclear. The aim of this study was to determine a global estimate of trauma registry activity.

Methods

A structured review of the literature was performed. All abstracts referring to a trauma registry over a two-year period were included. For the trauma registry described in each abstract, the source country was recorded. An additional search of web pages posted over a one year period was conducted. Those linked to an active trauma registry website were included and the country of the trauma registry was recorded. A selection of trauma registries from countries of different levels of development were identified and compared.

Results

571 abstracts were included in the review. Most articles utilised “general” trauma registries (436(76%)) and were based at a single hospital (279(49%)). Other registries were limited to military or paediatric populations (36(6%) and 35(6%) articles respectively). Most articles sourced registries from the US (288(50%)), followed by Australia (45(8%)), Germany (32(6%)), Canada (27(5%)), UK (13(2%)), China (13(2%)) and Israel (12(2%)). The Americas produced most trauma registry articles and South East Asia the least. The majority of trauma registry articles originated from very highly developed countries 467(82%). Least developed countries had the fewest (5(1%)). The additional search yielded 37 web pages linked to 27 different trauma registry websites. Most of these were based in the US (16(59%)). The basic features of trauma registries, such as inclusion criteria, number and type of variables and injury severity scoring, varied widely depending on the country's level of development.

Conclusion

This review, using a combination of the number of trauma registry articles and web pages to locate active trauma registries, demonstrated the disparity in trauma registry activity between the most and least developed countries. The absence of trauma care information systems remains a challenge to trauma system development globally.

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.

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