Implementation Of Trauma Registry Research Articles

Understanding the barriers and facilitators to trauma registry development in resource-constrained settings: A survey of trauma registry stewards and researchers

BackgroundThe implementation of trauma registries has proven a highly effective means of injury control. However, many low and middle-income countries lack trauma registries. Those that have trauma registries vary widely in terms of both implementation and structure. We sought to identify the most common barriers that stand in the way of sustainable trauma registry implementation, and the types of strategies that have proven successful in overcoming these barriers. MethodsWe conducted a questionnaire of trauma registry stewards and researchers in LMICs. ResultsTwenty-two individuals responded to the questionnaire representing trauma registry experiences across thirteen LMICs. The most common barriers to trauma registry implementation identified included staffing, funding, and stakeholder engagement. Many different strategies for addressing these barriers were discussed. Those mentioned by multiple respondents included the need for a trauma registry champion, fostering strong stakeholder relationships, and improving efficiency of data collection. ConclusionsThough trauma registry implementation and structure may differ from place to place, there are many shared barriers and facilitators that can be learned from. Identifying these common experiences can help create a repository of knowledge that can better serve those looking to implement their own trauma registries in similar settings.

Barriers and facilitators to implementing trauma registries in low- and middle-income countries: Qualitative experiences from Tanzania.

BackgroundThe burden of trauma in low and middle-income countries (LMICs) is disproportionately high: LMICs account for nearly 90% of the global trauma deaths. Lack of trauma data has been identified as one of the major challenges in addressing the quality of trauma care and informing injury-preventing strategies in LMICs. This study aimed to explore the barriers and facilitators of current trauma documentation practices towards the development of a national trauma registry (TR).MethodsAn exploratory qualitative study was conducted at five regional hospitals between August 2018 and December 2018. Five focus group discussions (FGDs) were conducted with 49 participants from five regional hospitals. Participants included specialists, medical doctors, assistant medical officers, clinical officers, nurses, health clerks and information communication and technology officers. Participants came from the emergency units, surgical and orthopaedic inpatient units, and they had permanent placement to work in these units as non-rotating staff. We analysed the gathered information using a hybrid thematic analysis.ResultsInconsistent documentation and archiving system, the disparity in knowledge and experience of trauma documentation, attitudes towards documentation and limitations of human and infrastructural resources in facilities we found as major barriers to the implementation of trauma registry. Health facilities commitment to standardising care, Ministry of Health and medicolegal data reporting requirements, and insurance reimbursements criteria of documentation were found as major facilitators to implementing trauma registry.ConclusionsImplementation of a trauma registry in regional hospitals is impacted by multiple barriers related to providers, the volume of documentation, resource availability for care, and facility care flow processes. However, financial, legal and administrative data reporting requirements exist as important facilitators in implementing the trauma registry at these hospitals. Capitalizing in the identified facilitators and investing to address the revealed barriers through contextualized interventions in Tanzania and other LMICs is recommended by this study.

Trauma registry implementation and operation in low and middle income countries: A scoping review

ABSTRACTInjury is a major public health crisis contributing to more than 4.48 million deaths annually. Trauma registries have proven highly effective in reducing injury morbidity and mortality rates in high income countries. They are a critical source of information for injury prevention, benchmarking care, quality improvement, and resource allocation. Historically, low and middle income countries (LMICs) have largely been excluded from trauma registry development due to limited resources. Recently, this has begun to change with low-resource hospitals adopting innovative strategies to implement trauma registries. Nonetheless, dissemination of these strategies remains fragmented. Hospitals looking to develop their own trauma registries have no current, comprehensive resource that summarises the implementation decisions of other registries in similar contexts. This scoping review aims to identify where trauma registries are located in LMICs, bringing up to date previous estimates, and to identify the most common approaches to registry implementation and operation in these settings.

Factors contributing to successful trauma registry implementation in low- and middle-income countries: A systematic review

BackgroundTrauma registries (TR) provide invaluable data, informing resource allocation and quality improvement. The purpose of this systematic review was to identify factors promoting and inhibiting successful TR implementation in low- and middle-income countries (LMICs). MethodsThe protocol was registered a priori (CRD42017058586). With librarian oversight, a peer-reviewed search strategy was developed. Adhering to PRISMA guidelines, two independent reviewers performed first-screen and full-text screening. Studies describing implementation of a TR in LMICs or reviewed the experience of registry users/implementers were included. Extracted data, focusing on publication, institution, registry and data factors, was summarized using descriptive statistics and subjected to thematic qualitative analysis. ResultsOut of 3842 screened references, 40 articles were included for analysis. Most registries were paper-based, implemented in single publicly-funded institutions within LMICs, benefited from funding, and were run by untrained house-staff with other clinical responsibilities. Constituent variables, injury scoring, outcome assessment, and quality assurance practices were very diverse. Principal obstacles to successful implementation were lack of funding, significant missing data, and insufficient resources. ConclusionsThis work may contribute to the planning of future efforts towards TR implementation in LMICs, where better injury data has the potential to alleviate the morbidity and mortality associated with trauma through advocacy and quality-improvement.

Strategies for successful trauma registry implementation in low- and middle-income countries\u2014protocol for a systematic review

BackgroundThe benefits of trauma registries have been well described. The crucial data they provide may guide injury prevention strategies, inform resource allocation, and support advocacy and policy. This has been shown to reduce trauma-related mortality in various settings. Trauma remains a leading cause of mortality in low- and middle-income countries (LMICs). However, the implementation of trauma registries in LMICs can be challenging due to lack of funding, specialized personnel, and infrastructure. This study explores strategies for successful trauma registry implementation in LMICs.MethodsThe protocol was registered a priori (CRD42017058586). A peer-reviewed search strategy of multiple databases will be developed with a senior librarian. As per PRISMA guidelines, first screen of references based on abstract and title and subsequent full-text review will be conducted by two independent reviewers. Disagreements that cannot be resolved by discussion between reviewers shall be arbitrated by the principal investigator. Data extraction will be performed using a pre-defined data extraction sheet. Finally, bibliographies of included articles will be hand-searched. Studies of any design will be included if they describe or review development and implementation of a trauma registry in LMICs. No language or period restrictions will be applied. Summary statistics and qualitative meta-narrative analyses will be performed.DiscussionThe significant burden of trauma in LMIC environments presents unique challenges and limitations. Adapted strategies for deployment and maintenance of sustainable trauma registries are needed. Our methodology will systematically identify recommendations and strategies for successful trauma registry implementation in LMICs and describe threats and barriers to this endeavor.Systematic review registrationThe protocol was registered on the PROSPERO international prospective register of systematic reviews (CRD42017058586).

Implementation of a Hospital-based Trauma Registry in Santa Cruz de la Sierra, Bolivia: Methodology, Preliminary Results, and Lessons learned

ABSTRACT Aim Five million annual global deaths are attributable to injuries. Yet, a lack of reliable data leaves the true magnitude of injuries unknown in many low- and middle-income countries (LMICs), like Bolivia. Trauma registries provide a means of acquiring these data. We sought to evaluate methodology, preliminary results, and lessons learned during the implementation of a pilot, hospital-based trauma registry at one facility in Santa Cruz de la Sierra, Bolivia. Materials and methods Data collection occurred from January to September 2015 at Clínica Foianini, a private, 50-bed, third-level facility in Santa Cruz. A paper trauma registry form based on the Panamerican Trauma Society's (ATS's) essential elements model was utilized. Trained nurses completed forms at a trauma patient's initial hospital presentation. Results were analyzed via descriptive statistics. Results The registry produced 91 forms over 8 months. An ICD-10 diagnosis code search of hospital visits showed 2,816 eligible patients, with a registry capture rate of 3.2%. Most were males (59.3%) in their mid-20s with head contusions (19.8%), penetrating/lacerating upper extremity (11.0%) or head (7.7%) wounds, or upper extremity fractures (6.6%). Many forms were missing critical data, with average omissions of 12.5 per form (26.0% of questions) and 23.7 per question (26.0% of subjects). Errors averaged 1.0 per form (2.1% of questions) and 2.0 per question (2.2% of subjects). Conclusion Early efforts to implement a paper-based trauma registry at one Bolivian hospital highlight areas for improvement, mainly within education, training, and oversight. Lessons learned will inform long-term objectives to make the registry a standard hospital program across the city, and eventually throughout Bolivia, arming decision-makers with data for targeted trauma initiatives that save lives. Clinical significance These results provide insight into trauma registry implementation in LMICs, which serves to further inform the Bolivian program and can be applied to comparable initiatives in similar settings. How to cite this article Boeck MA, Blair KJ, Foianini JE, Perry HB, Mata LV, Aboutanos MB, Haider AH, Swaroop M. Implementation of a Hospital-based Trauma Registry in Santa Cruz de la Sierra, Bolivia: Methodology, Preliminary Results, and Lessons learned. Panam J Trauma Crit Care Emerg Surg 2016;5(2):101-112.

Traffic medicine in Saudi Arabia, from prevention to rehabilitation

Saudi Arabia is a vast country of 2,149,690 km2, and is the largest Arab state in Western Asia. The Kingdom has been categorized as a high-income nation, and is part of the “Group of Twenty” (G-20) of major economies. It has a total population of approximately 27 million, one-fourth of whom are expatriates, with the highest population density (per km2) of 101 in Jizan, and 38 in Makkah, and the lowest of 2.8 in Najran, and 3.6 in Al Jawf. In KSA, motor vehicles are the main means of transportation within, and in-between cities. According to a recent estimate, more than 6 million cars are found on the roads of KSA. According to the morbidity and mortality records in the Ministry of Health (MOH) hospitals, 20% of beds are occupied by RTA victims, and 81% of deaths in the hospitals are due to RTIs. Over the past 2 decades, KSA has recorded 86,000 deaths, and 611,000 injuries in RTAs with 7% resulting in permanent disabilities. Road traffic accidents are a major health hazard with 19 killed daily, and 4 injured every hour in KSA. Al Naami et al, in his article mentioned the common reasons behind the soaring numbers of road traffic accidents in Saudi Arabia, which included the human factor, the vehicle, and the road/environment (2). Among the human factor, Driver errors account for about 80% of all RTAs in Saudi Arabia. Overspeeding is responsible for 65% of all traffic accidents (3.5 times the incidence in the USA). Violation of traffic signals at urban intersections is responsible for about 50% of accidents (4.5 times more common than in the USA). Vehicles and road layouts contribute to accidents and account for 20% of RTAs in Saudi Arabia, Tire blowouts and poor roads are very “hot” safety issues in Saudi Arabia, particularly in rural areas. Environmental factors such as rain, fog, and dust have minimal effects on RTAs in Saudi Arabia. However, extreme heat is responsible for 39% of all accidents due to tire blowouts. Heat also contributes to driver stress levels, leading to reduced mental capacity. Traffic medicine in Saudi Arabia has focused more on the prevention approach rather than the rehabilitation, The evidence sufficiently supports that the action plans in KSA so far have mostly focused on the prevention of RTIs rather than RTAs, including seat belt laws, Saher system, emergency medical rescue services, and the role of the police in the documentation of RTAs. While the international recommendations emphasize on developing institutional framework, safer roads and vehicles, proper surveillance or data system, safer road users, and post-crash care. The MOH in collaboration with the Ministry of Interior launched a road safety program called Saher in 2009. It is an automated system that was developed to manage traffic via electronic systems in major cities in Saudi Arabia, this newly established system uses a digital camera network connected to the national information center to track any violations and to control traffic. However, data on its long term effects on accidents and death are not yet available(3). Another important aspect of traffic medicine is the implementation of Trauma Registry as part of the national trauma system project, trauma registries can provide information on injury pattern and allow statistical modeling of trauma related variables to identify public health threats and prioritize interventions. Additionally registries can help monitor the epidemiology of serious injuries, track hospital performance overtime, and benchmark outcomes between hospitals and regions(4). Education and training of Trauma Human resources is another important aspect, King Abdulaziz Medical City has took the lead in a lot of medical fields disciplinary including medical education and has given trauma a major importance were KAMC has the largest ER outside North America and the 4th largest in the world. KAMC has the lead nationally if not in the region in regard to trauma courses where the main office to those courses is in King Abdulaziz Medical City.

Young, male, road traffic victims: a systematic review of the published trauma registry literature from low and middle income countries.

Background: Trauma contributes significantly to the global burden of disease. We analysed published trauma registries to assess the demographics of those most affected in low and middle-income countries (LMICs). Methods: We performed a systematic review of published trauma registry studies according to PRISMA guidelines. We included published full-text articles from trauma registries in low and middle-income countries describing the demographics of trauma registry patients. Articles from military trauma registries, articles using data not principally derived from trauma registry data, articles describing patients of only one demographic (e.g. only paediatric patients), or only one mechanism of injury, trauma registry implementation papers without demographic data, review papers and conference proceedings were excluded. Results: The initial search retrieved 1868 abstracts of which 1324 remained after duplicate removal. After screening the abstracts, 78 full-text articles were scrutinised for their suitability for inclusion. Twenty three papers from 14 countries, including 103,327 patients, were deemed eligible and included for analysis. The median age of trauma victims in these articles was 27 years (IQR 25–29). The median percentage of trauma victims who were male was 75 (IQR 66–84). The median percentage of road traffic injuries (RTIs) as a percentage of total injuries caused by trauma was 46 (IQR 21–71). Conclusions: Young, male, road traffic victims represent a large proportion of the LMIC trauma burden. This information can inform and be used by local and national governments to implement road safety measures and other strategies aimed at reducing the injury rate in young males.

Implementation of a trauma registry in a Brazilian public hospital: the first 1,000 patients.

Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database. Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais) and analysis of the initial results of the first 1,000 patients. The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS) could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7%) and the importance of aggression as a cause of injuries in our environment (47.5%), surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%. Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.

History and development of trauma registry: lessons from developed to developing countries

BackgroundA trauma registry is an integral component of modern comprehensive trauma care systems. Trauma registries have not been established in most developing countries, and where they exist are often rudimentary and incomplete. This review describes the role of trauma registries in the care of the injured, and discusses how lessons from developed countries can be applied toward their design and implementation in developing countries.MethodsA detailed review of English-language articles on trauma registry was performed using MEDLINE and CINAHL. In addition, relevant articles from non-indexed journals were identified with Google Scholar.ResultsThe history and development of trauma registries and their role in modern trauma care are discussed. Drawing from past and current experience, guidelines for the design and implementation of trauma registries are given, with emphasis on technical and logistic factors peculiar to developing countries.ConclusionImprovement in trauma care depends on the establishment of functioning trauma care systems, of which a trauma registry is a crucial component. Hospitals and governments in developing countries should be encouraged to establish trauma registries using proven cost-effective strategies.

Reporting data following major trauma and analysing factors associated with outcome using the new Utstein style recommendations

Study objective: To collect and present retrospectively the recommended core data from the Utstein style, analyse factors associated with outcome in major trauma, and discuss the value of the Utstein style definition of major trauma. Design: A retrospective trauma cohort study. Setting: A Norwegian trauma system with a 1200 bed combined local and referral trauma hospital without a formal trauma registry, covering a population of ≈2.0 million. Participants: 3391 injured patients admitted 12 months from January 15, 1996. Main outcome measures: Recommended core data from the Utstein style, and factors associated with outcome defined as in-hospital death within 30 days. Results: 225 patients had an injury severity score (ISS)>15. In each of the 225 patients, we were able to obtain at least 47% of the recommended core data. Age >70 years, fall as a mechanism of injury, and a Trauma Score (TS)≤14 were significantly associated with poor outcome. Of 22 with no major trauma (ISS<16), two died in hospital and 20 had an intensive care unit stay of more than 2 days. Conclusion: We found it difficult to collect retrospectively the recommended core data of the Utstein style. Age and physiological alterations (TS) were significantly related to outcome. The recommended definition of major trauma (ISS>15) did not cover all life-threatening injuries. The implementation of trauma registries based on the Utstein style recommendations could facilitate system evaluation and comparison, but definitions and categorisations should be further developed. Efforts should be made to reduce the number of core data.