Measuring the Impact of Trauma in Greece: A Systematic Review of Greek Trauma Registries. Is Quality Improvement Achievable?

Abstract

Greece currently has no national trauma registry. The primary aim of this study was to identify all the trauma registries that have been established in Greece and assess the methodology used in these registries. The secondary aim was investigation, through review of the registries, of the demographics, mechanisms of injury, severity of injuries, and mortality of Greek trauma patients. We performed a systematic review of published trauma registry literature from Greece, according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We assessed the methodology of the registries, based on the reported physical and human resources, administration strategies, processes of data collection, and analysis. SPSS was used for the synthesis of the quantitative data extracted from the registries (demographics, mechanisms of injury, injury severity score [ISS], mortality). The initial search retrieved 1,732 abstracts, after screening of which, 81 full-text articles were scrutinized for their suitability for inclusion. Finally, 14 papers from 6 registries, including a total 159,763 patients, were deemed eligible. Each registry used different inclusion criteria. Half of the publications (7/14) were derived from registries that received funding. Regarding the analysis included in the studies, epidemiological analysis was the most common (12/14), followed by comparisons (internal or external) (6/14). Quality improvement analysis was not presented in any publication. The mean age of the patients was 41±7.3 years, and 63.17% were males. Road traffic accidents (RTAs) were the most common mechanism of injury (38.19%), followed by falls (36.1%). The registries used a variety of different ISS thresholds for considering a trauma patient severely injured; the mean ISS threshold used was 12±5. The mean ISS of the entire population was 8.4±4.4 and the average mortality was 3.85%. RTAs and falls are responsible for a significant proportion of the Greek trauma burden. The small number of publications of the data from the registries and the complete absence of quality control studies indicate that trauma auditing in Greece is still in an embryonic state. There is a pressing need for national consensus on how to record and investigate trauma.