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Klappenbach R, Monteverde E, Santero M, Bosque L, Neira J. Budget impact analysis of implementing trauma registries in Argentina. Injury 2024; 55:111781. [PMID: 39154489 DOI: 10.1016/j.injury.2024.111781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/03/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION In high-income countries, quality improvement interventions and research are usually guided by trauma registries. In low- and middle-income countries, the implementation of trauma registries has been limited mainly for cost reasons. OBJECTIVE To analyze the budgetary impact of the implementation of trauma registries in Argentina. METHODS We estimated direct costs of implementing trauma registries in public hospitals located in cities with a population over 50,000 inhabitants. In large urban areas, we selected hospitals by estimating a minimum volume of 240 severe trauma admissions/year and using the NBATS-2 instrument with geolocation techniques. We estimated costs based on a micro-costing approach of a trauma registry developed by Fundación Trauma. Scenario analysis was carried out restricting the population to hospitals from bigger cities and/or with higher concentration of trauma patients' care. For the high budget impact threshold, we used the total health spending estimation, and alternatively the health spending of the public sector. RESULTS For the base case, 139 hospitals from 104 cities were included, comprising 175,605 injury-related discharges and 13,707 severely injured patients/year. The average cost for the initial three years was USD 3,753,085 (21.4 USD/per patient), falling below the high budget impact thresholds. The scenarios analysis showed a significantly costs reduction. CONCLUSIONS The implementation of trauma registries in Argentina would be affordable, and in consequence, it would improve the coordination, management and quality of care for this great public health issue.
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Affiliation(s)
| | | | - Marilina Santero
- Fundación Trauma, Tacuarí 352, (C1071AAH), Buenos Aires, Argentina; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Bosque
- Fundación Trauma, Tacuarí 352, (C1071AAH), Buenos Aires, Argentina
| | - Jorge Neira
- Fundación Trauma, Tacuarí 352, (C1071AAH), Buenos Aires, Argentina
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Bhatia MB, Keung CH, Hogan J, Chepkemoi E, Li HW, Rutto EJ, Tenge R, Kisorio J, Hunter-Squires JL, Saula PW. Implementation of a pediatric trauma registry at a national referral center in Kenya: Utility and concern for sustainability. Injury 2024; 55:111531. [PMID: 38704346 DOI: 10.1016/j.injury.2024.111531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Pediatric trauma disproportionately affects low- and middle-income countries, particularly the pediatric trauma systems, are frequently limited. This study assessed the patterns of pediatric traumatic injuries and treatment at the only free-standing public children's hospital in East Africa as well as the implementation and sustainability of the trauma registry. METHODS A prospective pediatric trauma registry was established at Shoe4Africa Children's Hospital (S4A) in Eldoret, Kenya. All trauma patients over a six-month period were enrolled. Descriptive analyses were completed via SAS 9.4 to uncover patterns of demographics, trauma mechanisms and injuries, as well as outcomes. Implementation was assessed using the RE-AIM framework. RESULTS The 425 patients had a median age of 5.14 years (IQR 2.4, 8.7). Average time to care was 267.5 min (IQR 134.0, 625.0). The most common pediatric trauma mechanisms were falls (32.7 %) and burns (17.7 %), but when stratified by age group, toddlers had a higher risk of sustaining injuries from burns and poisonings. Over half (56.2 %) required an operation during the hospitalization. Overall, implementation of the registry was limited by the clinical burden and inadequate personnel. Sustainability of the registry was limited by finances. CONCLUSIONS This is the first study to describe the trauma epidemiology from a Kenyan public pediatric hospital. Maintenance of the trauma registry failed due to cost. Streamlining global surgery efforts through implementation science may allow easier development of trauma registries to then identify modifiable risk factors to prevent trauma and long-term outcomes to understand associated disability.
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Affiliation(s)
- Manisha B Bhatia
- Indiana University Department of Surgery, Indianapolis, IN, USA.
| | | | - Jessica Hogan
- University of Alberta, Department of Surgery, Alberta, Canada
| | | | - Helen W Li
- Washington University Department of Surgery, St. Louis, Missouri, USA
| | | | - Robert Tenge
- Moi University, Department of Anesthesia and Surgery, Eldoret, Kenya
| | - Joshua Kisorio
- Moi University, Department of Anesthesia and Surgery, Eldoret, Kenya
| | | | - Peter W Saula
- Moi University, Department of Anesthesia and Surgery, Eldoret, Kenya
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Karami M, Hafizi N, Nickfarjam AM, Refahi S. Development of minimum data set and dashboard for monitoring adverse events in radiology departments. Heliyon 2024; 10:e30054. [PMID: 38707457 PMCID: PMC11068645 DOI: 10.1016/j.heliyon.2024.e30054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background To reduce the risk of errors, patient safety monitoring in the medical imaging department is crucial. Interventions are required and these can be provided as a framework for documenting, reporting, evaluating, and recognizing events that pose a threat to patient safety. The aim of this study was to develop minimum data set and dashboard for monitoring adverse events in radiology departments. Material and methods This developmental research was conducted in multiple phases, including content determination using the Delphi technique; database designing using SQL Server; user interface (UI) building using PHP; and dashboard evaluation in three aspects: the accuracy of calculating; UI requirements; and usability. Results This study identified 26 patient safety (PS) performance metrics and 110 PS-related significant data components organized into 14 major groupings as the system contents. The UI was built with three tabs: pre-procedure, intra-procedure, and post-procedure. The evaluation results proved the technical feasibility of the dashboard. Finally, the dashboard's usability was highly rated (76.3 out of 100). Conclusion The dashboard can be used to supplement datasets to obtain a more accurate picture of the PS condition and to draw attention to characteristics that professionals might otherwise overlook or undervalue.
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Affiliation(s)
- Mahtab Karami
- Clinical Research Development Center of Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Research Center for Health Technology Assessment and Medical Informatics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Health Information Technology and Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasrin Hafizi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali-Mohammad Nickfarjam
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Technology and Management, School of Allied-Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Soheila Refahi
- Department of Medical Physics, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Mughal NA, Hussain MH, Ahmed KS, Waheed MT, Munir MM, Diehl TM, Zafar SN. Barriers to Surgical Outcomes Research in Low- and Middle-Income Countries: A Scoping Review. J Surg Res 2023; 290:188-196. [PMID: 37269802 DOI: 10.1016/j.jss.2023.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/04/2023] [Accepted: 04/30/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Systematic collection and analysis of surgical outcomes data is a cornerstone of surgical quality improvement. Unfortunately, there remains a dearth of surgical outcomes data from low- and middle-income countries (LMICs). To improve surgical outcomes in LMICs, it is essential to have the ability to collect, analyze, and report risk-adjusted postoperative morbidity and mortality data. This study aimed to review the barriers and challenges to developing perioperative registries in LMIC settings. METHODS We conducted a scoping review of all published literature on barriers to conducting surgical outcomes research in LMICs using PubMed, Embase, Scopus, and GoogleScholar. Keywords included 'surgery', 'outcomes research', 'registries', 'barriers', and synonymous Medical Subject Headings derivatives. Articles found were subsequently reference-mined. All relevant original research and reviews published between 2000 and 2021 were included. The performance of routine information system management framework was used to organize identified barriers into technical, organizational, or behavioral factors. RESULTS Twelve articles were identified in our search. Ten articles focused specifically on the creation, success, and obstacles faced during the implementation of trauma registries. Technical factors reported by 50% of the articles included limited access to a digital platform for data entry, lack of standardization of forms, and complexity of said forms. 91.7% articles mentioned organizational factors, including the availability of resources, financial constraints, human resources, and lack of consistent electricity. Behavioral factors highlighted by 66.6% of the studies included lack of team commitment, job constraints, and clinical burden, which contributed to poor compliance and dwindling data collection over time. CONCLUSIONS There is a paucity of published literature on barriers to developing and maintaining perioperative registries in LMICs. There is an immediate need to study and understand barriers and facilitators to the continuous collection of surgical outcomes in LMICs.
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Affiliation(s)
- Nabiha Akhlaq Mughal
- Department of Surgery, Aga Khan University Medical College, Karachi, Sindh, Pakistan
| | - Muzamil Hamid Hussain
- Department of Surgery, Aga Khan University Medical College, Karachi, Sindh, Pakistan
| | | | - Muhammad Talha Waheed
- Department of Surgery, Aga Khan University Medical College, Karachi, Sindh, Pakistan; Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Muhammad Musaab Munir
- Department of Surgery, Aga Khan University Medical College, Karachi, Sindh, Pakistan
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
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Kapanadze G, Berg J, Sun Y, Gerdin Wärnberg M. Facilitators and barriers impacting in-hospital Trauma Quality Improvement Program (TQIP) implementation across country income levels: a scoping review. BMJ Open 2023; 13:e068219. [PMID: 36806064 PMCID: PMC9944272 DOI: 10.1136/bmjopen-2022-068219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE Trauma is a leading cause of mortality and morbidity globally, disproportionately affecting low/middle-income countries (LMICs). Understanding the factors determining implementation success for in-hospital Trauma Quality Improvement Programs (TQIPs) is critical to reducing the global trauma burden. We synthesised topical literature to identify key facilitators and barriers to in-hospital TQIP implementation across country income levels. DESIGN Scoping review. DATA SOURCES PubMed, Web of Science and Global Index Medicus databases were searched from June 2009 to January 2022. ELIGIBILITY CRITERIA Published literature involving any study design, written in English and evaluating any implemented in-hospital quality improvement programme in trauma populations worldwide. Literature that was non-English, unpublished and involved non-hospital TQIPs was excluded. DATA EXTRACTION AND SYNTHESIS Two reviewers completed a three-stage screening process using Covidence, with any discrepancies resolved through a third reviewer. Content analysis using the Consolidated Framework for Implementation Research identified facilitator and barrier themes for in-hospital TQIP implementation. RESULTS Twenty-eight studies met the eligibility criteria from 3923 studies identified. The most discussed in-hospital TQIPs in included literature were trauma registries. Facilitators and barriers were similar across all country income levels. The main facilitator themes identified were the prioritisation of staff education and training, strengthening stakeholder dialogue and providing standardised best-practice guidelines. The key barrier theme identified in LMICs was poor data quality, while high-income countries (HICs) had reduced communication across professional hierarchies. CONCLUSIONS Stakeholder prioritisation of in-hospital TQIPs, along with increased knowledge and consensus of trauma care best practices, are essential efforts to reduce the global trauma burden. The primary focus of future studies on in-hospital TQIPs in LMICs should target improving registry data quality, while interventions in HICs should target strengthening communication channels between healthcare professionals.
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Affiliation(s)
- George Kapanadze
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Johanna Berg
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Emergency and Internal Medicine, Skånes universitetssjukhus Malmö, Malmo, Sweden
| | - Yue Sun
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Lakshmi JK, Tetali S, Moran D, Wadhwaniya S, Gupta S, Gururaj G, Hyder AA. Traffic, training, and turnover: Experiences of research personnel in collecting road safety data in Hyderabad, India. WHO South East Asia J Public Health 2022; 10:47-52. [PMID: 35046158 DOI: 10.4103/who-seajph.who-seajph_37_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We describe the experiences of research personnel in collecting road safety data, using a range of quantitative and qualitative methods to collect primary and secondary data, in the course of monitoring and evaluating the impact of road safety interventions under the Bloomberg Philanthropies Global Road Safety Program, in Hyderabad, India. We detail environmental, administrative, and operational barriers encountered, and individual, systemic, and technical enablers pertaining to the conduct of road safety research in Hyderabad, India, but bearing relevance to broader public health research and practice and the implementation and evaluation of projects. From our experiences of the challenges and the solutions developed to address them, we set out recommendations for research teams and for administrators in road safety as well as in various other streams of public health research and practice. We propose actionable strategies to enhance data-collectors' safety; build effective partnerships with various stakeholders, including research collaborators, administrators, and communities; and strengthen data quality and streamlining systems, particularly in similar geo-political settings.
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Affiliation(s)
- Josyula K Lakshmi
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India; The George Institute for Global Health, India; Faculty of Medicine, UNSW, Sydney, Australia; Prasanna School of Public Health, MAHE, Manipal, India
| | - Shailaja Tetali
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, India
| | - Dane Moran
- Johns Hopkins Medicine International; Baylor College of Medicine, Texas, USA
| | | | - Shivam Gupta
- Johns Hopkins International Injury Research Unit, USA
| | | | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit; Milken Institute School of Public Health, George Washington University, USA
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Tanoli O, Ahmad H, Khan H, Khattak FA, Khan A, Mikhail A, Deckelbaum D, Razek T. A pilot trauma registry in Peshawar, Pakistan - A roadmap to decreasing the burden of injury - Quality improvement study. Ann Med Surg (Lond) 2021; 72:103137. [PMID: 34934485 PMCID: PMC8654792 DOI: 10.1016/j.amsu.2021.103137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/LOCAL PROBLEM In Pakistan, trauma is a significant public health issue accounting for the second leading cause of disability and fifth for healthy years of life lost. Well-developed trauma systems, utilizing trauma registries, have been proven to decrease morbidity and mortality from injuries, and helped to reduce the number of injured patients. In Pakistan, most data on injury are acquired through methods that are retrospective, incomplete, and open to recall bias. To that end, a trauma registry was piloted at the Lady Reading Hospital (LRH) in Peshawar, Pakistan to elucidate the importance of trauma registries in designing healthcare targeted quality improvement initiatives. INTERVENTION Upon receiving ethics approval, a twenty-five-point registry was piloted at the Lady Reading Hospital. METHODS The pilot implementation was carried out from May 9th to May 13th, 2018. RESULTS A total of 267 patients were included in the pilot registry. Motor vehicle collisions were the most prevalent cause of injury (46%). The other causes of injury included falls (24%), blunt assaults (9%), stabs/cuts (8%), gunshots (6%), crush injuries (3%), burns (2%), and blasts/landmines (2%). Most patients were treated in the trauma bay and required no further acute intervention (51%). CONCLUSION This 5-day pilot trauma registry was the first of its kind in Peshawar, Pakistan, and despite its short course, an immense amount of data was garnered on the epidemiology of injury in the region. Significantly, the data collected can already be used to develop evidence-based changes, which will effectively minimize the impact of trauma.
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Affiliation(s)
- Omaid Tanoli
- McGill University Health Centre, Centre for Global Surgery, Montreal, Qc, Canada
- University of Toronto, Department of General Surgery, Toronto, On, Canada
| | - Hamza Ahmad
- McGill University Health Centre, Centre for Global Surgery, Montreal, Qc, Canada
| | - Haider Khan
- Bacha Khan Medical College, Mardan, Khyber Pakhtunkhwa, Pakistan
| | | | - Awais Khan
- Khyber Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Alexandre Mikhail
- University of Toronto, Department of General Surgery, Toronto, On, Canada
| | - Dan Deckelbaum
- McGill University Health Centre, Centre for Global Surgery, Montreal, Qc, Canada
| | - Tarek Razek
- McGill University Health Centre, Centre for Global Surgery, Montreal, Qc, Canada
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Grant CL, Tumuhimbise C, Ninsiima C, Robinson T, Eurich D, Bigam D, Situma M, Saleh A. Improved documentation following the implementation of a trauma registry: A means of sustainability for trauma registries in low- and middle-income countries. Injury 2021; 52:2672-2676. [PMID: 34334209 DOI: 10.1016/j.injury.2021.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma registries in low- and middle-income countries (LMICs) are critical for improving trauma care; however, while some registries have been established in low-income settings, few are sustained due to a lack of sustainable funding. In many LMIC institutions, funding is dependent on documentation of trauma patients, but patient records may be of poor quality, missing, or incomplete. The development of a trauma registry and electronic patient registration system could be used to improve documentation of trauma patients in a low-income setting and lead to increased funding for trauma care. METHODS A retrospective chart review of trauma patients at Mbarara Regional Referral Hospital in Uganda was performed, documenting the monthly admissions from January 2015-July 2016 prior to the establishment of a trauma registry. A trauma registry and electronic patient registration system were established in 2017, and monthly admissions from February 2017-December 2019 were documented. A negative binomial regression analysis was performed comparing the incident rate of admission pre-implementation of the registry compared to post-implementation, adjusting for month and year. Completeness of trauma patient records was also assessed. RESULTS Prior to the implementation of the trauma registry and patient registration system (2015-2016), there was a mean of 5.2 (SD 4.4) trauma records per month identified. Following the implementation of the trauma registry, a mean of 103.4 trauma records per month were documented (SD 32.0) for an increased incident rate ratio of 20.9 (95% CI 15.7-27.6, p<0.001). There was also a significant increase in percentage of documents completed (OR 49.1, CI 12.4-193.7, p<0.001). DISCUSSION Following the implementation of a trauma registry and electronic patient registration system at this low-income country hospital, an increase of 20.9 times completed trauma patient documentation was identified, and completion of the records improved. This more accurate documentation could be used to apply for increased government funding for trauma patients and sustain the trauma registry in the long term and could represent a means of long-term sustainability for other trauma registries in LMICs.
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Affiliation(s)
- Chantalle L Grant
- Department of Surgery, University of Alberta, Office of Global Surgery, 2D2.23 WMHC, 8440-112 St. NW, Edmonton, Alberta, Canada, T6G 2B7.
| | - Christine Tumuhimbise
- Mbarara Regional Referral Hospital, PO Box 1041, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Consolet Ninsiima
- Mbarara Regional Referral Hospital, PO Box 1041, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Tessa Robinson
- Department of Health Research Methods, Evidence, & Impact, McMaster University, 690 Water Street, Simcoe, Ontario, Canada, N3Y 4K1.
| | - Dean Eurich
- School of Public Health, University of Alberta, 2-040F Li Ka Shing Centre For Research, 11203 - 87 Ave NW, Edmonton AB Canada, T6G 2H5.
| | - David Bigam
- Department of Surgery, University of Alberta, Office of Global Surgery, 2D2.23 WMHC, 8440-112 St. NW, Edmonton, Alberta, Canada, T6G 2B7.
| | - Martin Situma
- Mbarara Regional Referral Hospital, PO Box 1041, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Health Research Methods, Evidence, & Impact, McMaster University, 690 Water Street, Simcoe, Ontario, Canada, N3Y 4K1.
| | - Abdullah Saleh
- Department of Surgery, University of Alberta, Office of Global Surgery, 2D2.23 WMHC, 8440-112 St. NW, Edmonton, Alberta, Canada, T6G 2B7.
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Lim AG, Kivlehan S, Losonczy LI, Murthy S, Dippenaar E, Lowsby R, Yang MLCLC, Jaung MS, Stephens PA, Benzoni N, Sefa N, Bartlett ES, Chaffay BA, Haridasa N, Velasco BP, Yi S, Contag CA, Rashed AL, McCarville P, Sonenthal PD, Shukur N, Bellou A, Mickman C, Ghatak-Roy A, Ferreira A, Adhikari NK, Reynolds T. Critical care service delivery across healthcare systems in low-income and low-middle-income countries: protocol for a systematic review. BMJ Open 2021; 11:e048423. [PMID: 34462281 PMCID: PMC8407204 DOI: 10.1136/bmjopen-2020-048423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Critical care in low-income and low-middle income countries (LLMICs) is an underdeveloped component of the healthcare system. Given the increasing growth in demand for critical care services in LLMICs, understanding the current capacity to provide critical care is imperative to inform policy on service expansion. Thus, our aim is to describe the provision of critical care in LLMICs with respect to patients, providers, location of care and services and interventions delivered. METHODS AND ANALYSIS We will search PubMed/MEDLINE, Web of Science and EMBASE for full-text original research articles available in English describing critical care services that specify the location of service delivery and describe patients and interventions. We will restrict our review to populations from LLMICs (using 2016 World Bank classifications) and published from 1 January 2008 to 1 January 2020. Two-reviewer agreement will be required for both title/abstract and full text review stages, and rate of agreement will be calculated for each stage. We will extract data regarding the location of critical care service delivery, the training of the healthcare professionals providing services, and the illnesses treated according to classification by the WHO Universal Health Coverage Compendium. ETHICS AND DISSEMINATION Reviewed and exempted by the Stanford University Office for Human Subjects Research and IRB on 20 May 2020. The results of this review will be disseminated through scholarly publication and presentation at regional and international conferences. This review is designed to inform broader WHO, International Federation for Emergency Medicine and partner efforts to strengthen critical care globally. PROSPERO REGISTRATION NUMBER CRD42019146802.
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Affiliation(s)
- Andrew George Lim
- Section of Critical Care Medicine, Virginia Mason Medical Center, Seattle, Washington, USA
- Division of Critical Care Medicine, Stanford University, Stanford, California, USA
| | - Sean Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Harvard University, Cambridge, Massachusetts, USA
| | - Lia Ilona Losonczy
- Department of Emergency Medicine, Department of Anaesthesia & Critical Care Medicine, The George Washington University Medical Center, Washington, District of Columbia, USA
| | - Srinivas Murthy
- Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Enrico Dippenaar
- Emergency Medicine Research Group, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Richard Lowsby
- Department of Critical Care Medicine, Department of Emergency Medicine, Mid Cheshire Hospitals NHS Foundation Trust, Cheshire, Cheshire, UK
| | - Marc Li Chuan L C Yang
- Accident and Emergency Medicine, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Michael S Jaung
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - P Andrew Stephens
- Department of Emergency Medicine, Intensive Care & Resuscitation, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nicole Benzoni
- Division of Pulmonary & Critical Care Medicine, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Nana Sefa
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Brandon Alexander Chaffay
- Department of Emergency Medicine, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Naeha Haridasa
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Bernadett Pua Velasco
- Department of Emergency Medicine, East Avenue Medical Center, Quezon City, National Capital Region, Philippines
| | - Sojung Yi
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Caitlin A Contag
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Amir Lotfy Rashed
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, New York, USA
| | - Patrick McCarville
- Department of Emergency Medicine, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Paul D Sonenthal
- Division of Pulmonary & Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Nebiyu Shukur
- Department of Emergency Medicine, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Carl Mickman
- Department of Emergency Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Adhiti Ghatak-Roy
- Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Allison Ferreira
- Department of Emergency Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Neill Kj Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
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Sawe HR, Reynolds TA, Weber EJ, Mfinanga JA, Coats TJ, Wallis LA. Development and pilot implementation of a standardised trauma documentation form to inform a national trauma registry in a low-resource setting: lessons from Tanzania. BMJ Open 2020; 10:e038022. [PMID: 33033093 PMCID: PMC7545631 DOI: 10.1136/bmjopen-2020-038022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Trauma registries are an integral part of a well-organised trauma system. Tanzania, like many low and middle-income countries, does not have a trauma registry. We describe the development, structure, implementation and impact of a context appropriate standardised trauma form based on the adaptation of the WHO Data Set for Injury (DSI), for clinical documentation and use in a national trauma registry. SETTING Our study was conducted in emergency units of five regional referral hospitals in Tanzania. PROCEDURES Mixed methods participatory action research was employed. After an assessment of baseline trauma documentation, we conducted semi-structured interviews with a purposefully selected sample of 33 healthcare providers from all participating hospitals to understand, develop, pilot and implement a standardised trauma form. We compared the number and types of variables captured before and after the form was implemented. OUTCOMES Change in proportion of variables of DSI captured after implementation of a standardised trauma documentation form. RESULTS Piloting and feedback informed the development of a context appropriate standardised trauma documentation paper form with carbonless copy that could be used as both the clinical chart and data capture. Among 721 patients (seen by 21 clinicians) during the initial 30-day pilot, overall variable capture was 86.4% of required variables. After modifications of the form and training of healthcare providers, the form was implemented for 7 months, during which the capture improved to 96.3% among 6302 patients (seen by 31 clinicians). The providers reported the form was user-friendly, resulted in less time documenting, and served as a guide to managing trauma patients. CONCLUSIONS The development and implementation of a contextually appropriate, standardised trauma form were successful, yielding increased capture rates of injury variables. This system will facilitate expansion of the trauma registry across the country and inform similar initiatives in Sub-Saharan Africa.
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Affiliation(s)
- Hendry R Sawe
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Teri A Reynolds
- Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Ellen J Weber
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Juma A Mfinanga
- Emergency Medicine, Muhimbili National Hospital, Dar es salaam, United Republic of Tanzania
| | - Timothy J Coats
- Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Lee A Wallis
- Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Developing a trauma registry in a middle-income country - Botswana. Afr J Emerg Med 2020; 10:S29-S37. [PMID: 33318899 PMCID: PMC7723909 DOI: 10.1016/j.afjem.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Botswana has a large burden of disease from injury, but no trauma registry. This study sought to design and pilot test a trauma registry at two hospitals. METHODS A cross sectional study was piloted at a tertiary hospital and a secondary level hospital in Botswana. The study consisted of two stages: stage 1 - stakeholders' consultation and trauma registry prototype was designed. Stage 2 consisted of two phases: Phase I involved retrospective collection of existing data from existing data collection tools and Phase II collected data prospectively using the proposed trauma registry prototype. RESULTS The pre-hospital road traffic accident data are collected using hard copy forms and some of these data were transferred to a stand-alone electronic registry. The hospital phase of road traffic accident data all goes into hard copy files then stored in institutional registry departments. The post-hospital data were also partially stored as hard copies and some data are stored in a stand-alone electronic registry. The demographics, pre-hospital, triage, diagnosis, management and disposition had a high percent variable completion rate with no significant difference between phases I and II. However, the primary survey variables in Phase I had a low percent variable completion rate which was significantly different from the high completion rates in phase II at both hospitals. A similar picture was observed for the secondary survey at both hospitals. CONCLUSION Electronic trauma registries are feasible and data completion rate is high when using the electronic data registry as opposed to data collected using the existing paper-based data collection tools.
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Design and Implementation of a Hospital-based Trauma Surveillance Registry in a Resource-Poor Setting: A Cost Analysis Study. Injury 2020; 51:1548-1553. [PMID: 32456956 PMCID: PMC7372905 DOI: 10.1016/j.injury.2020.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma is a leading cause of morbidity and mortality globally, with a disproportionate burden affecting low- and middle-income countries (LMIC). Rapid urbanization and differences in transportation patterns result in unique injury patterns in LMIC. Trauma registries are essential to determine the impact of trauma and the nature of injuries in LMIC to enable hospitals and healthcare systems to optimize care and to allocate resources. METHODS A retrospective database analysis of prospectively collected data in the Kamuzu Central Hospital (KCH) Trauma Registry from 2018 - 2019 was performed. Activity-based costing, a bottom-up cost analysis method to determine the cost per patient registered, was completed after systematically analyzing the standard operating procedures of the KCH trauma registry. RESULTS During the study period, 12,616 patients were included in the KCH Trauma Registry. Startup costs for the trauma registry are estimated at $3,196.24. This sum includes $1815.84 for personnel cost, $200 for database initiation (REDCap database), $342.50 for initial data clerk training, and $787.90 for registry and office supplies. Recurrent costs occurring in 2018, included personnel, technology, supply, and facility costs. Five data clerks, one data clerk manager, and a registry manager are required for 24/7 data collection, data integrity, and database maintenance, with an estimated cost of $29,697.24 per year. Yearly recurrent data clerk training costs are $137.00. Internet and facility costs for a data clerk office and secure record storage are $1632.60 per year. Supplies for the completion of trauma intake forms (binders, paper, pens) are $1431.80 per year. The total annual cost of the trauma registry at a tertiary hospital in Malawi is $33,361.64, which costs $2.64 per patient registered in the registry in 2018. CONCLUSION Trauma registries are necessary for the assessment of the local trauma burden and injury pattern, but require significant financial commitment and time. To fully capture the local burden of trauma in resource-limited settings, acquiring, validating, and analyzing accurate data is crucial. Anticipating the financial burden of a trauma surveillance registry ahead of time is imperative.
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Rosenkrantz L, Schuurman N, Arenas C, Nicol A, Hameed MS. Maximizing the potential of trauma registries in low-income and middle-income countries. Trauma Surg Acute Care Open 2020; 5:e000469. [PMID: 32426528 PMCID: PMC7228665 DOI: 10.1136/tsaco-2020-000469] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/24/2020] [Indexed: 11/03/2022] Open
Abstract
Injury is a major global health issue, resulting in millions of deaths every year. For decades, trauma registries have been used in wealthier countries for injury surveillance and clinical governance, but their adoption has lagged in low-income and middle-income countries (LMICs). Paradoxically, LMICs face a disproportionately high burden of injury with few resources available to address this pandemic. Despite these resource constraints, several hospitals and regions in LMICs have managed to develop trauma registries to collect information related to the injury event, process of care, and outcome of the injured patient. While the implementation of these trauma registries is a positive step forward in addressing the injury burden in LMICs, numerous challenges still stand in the way of maximizing the potential of trauma registries to inform injury prevention, mitigation, and improve quality of trauma care. This paper outlines several of these challenges and identifies potential solutions that can be adopted to improve the functionality of trauma registries in resource-poor contexts. Increased recognition and support for trauma registry development and improvement in LMICs is critical to reducing the burden of injury in these settings.
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Affiliation(s)
- Leah Rosenkrantz
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Claudia Arenas
- Division of Trauma Surgery, Hospital Sotero del Rio, Santiago, Chile.,Division of General Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Andrew Nicol
- Department of Surgery, University of Cape Town, Observatory, Western Cape, South Africa.,Trauma Centre, Groote Schuur Hospital, Observatory, Western Cape, South Africa
| | - Morad S Hameed
- Division of General Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Sawe HR, Sirili N, Weber E, Coats TJ, Reynolds TA, Wallis LA. Perceptions of health providers towards the use of standardised trauma form in managing trauma patients: a qualitative study from Tanzania. Inj Epidemiol 2020; 7:15. [PMID: 32354375 PMCID: PMC7193390 DOI: 10.1186/s40621-020-00244-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/02/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Trauma registries (TRs) are essential to informing the quality of trauma care within health systems. Lack of standardised trauma documentation is a major cause of inconsistent and poor availability of trauma data in most low- and middle-income countries (LMICs), hindering the development of TRs in these regions. We explored health providers' perceptions on the use of a standardised trauma form to record trauma patient information in Tanzania. METHODS An exploratory qualitative research using a semi-structured interview guide was carried out to purposefully selected key informants comprising of healthcare providers working in Emergency Units and surgical disciplines in five regional hospitals in Tanzania. Data were analysed using a thematic analysis approach to identify key themes surrounding potential implementation of the standardised trauma form. RESULTS Thirty-three healthcare providers participated, the majority of whom had no experience in the use of standardised charting. Only five respondents had prior experience with trauma forms. Responses fell into three themes: perspectives on the concept of a standardised trauma form, potential benefits of a trauma form, and concerns regarding successful and sustainable implementation. CONCLUSION Findings of this study revealed wide healthcare provider acceptance of moving towards standardised clinical documentation for trauma patients. Successful implementation likely depends on the perceived benefits of using a trauma form as a tool to guide clinical management, standardise care and standardise data reporting; however, it will be important moving forward to factor concerns brought up in this study. Potential barriers to successful and sustainable implementation of the form, including the need for training and tailoring of form to match existing resources and knowledge of providers, must be considered.
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Affiliation(s)
- Hendry R. Sawe
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nathanael Sirili
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ellen Weber
- Emergency Department, University of California, San Francisco, CA USA
| | - Timothy J. Coats
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Teri A. Reynolds
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Unit Head, Clinical Services and Systems, Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - Lee A. Wallis
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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15
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Sawe HR, Reynolds TA, Weber EJ, Mfinanga JA, Coats TJ, Wallis LA. Trauma care and capture rate of variables of World Health Organisation data set for injury at regional hospitals in Tanzania: first steps to a national trauma registry. BMC Emerg Med 2020; 20:29. [PMID: 32326896 PMCID: PMC7178583 DOI: 10.1186/s12873-020-00325-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background In Tanzania, there is no national trauma registry. The World Health Organization (WHO) has developed a data set for injury that specifies the variables necessary for documenting the burden of injury and patient-related clinical processes. As a first step in developing and implementing a national Trauma Registry, we determined how well hospitals currently capture the variables that are specified in the WHO injury set. Methods This was a prospective, observational cross-sectional study of all trauma patients conducted in the Emergency Units of five regional referral hospitals in Tanzania from February 2018 to July 2018. Research assistants observed the provision of clinical care in the EU for all patients, and documented performed assessment, clinical interventions and final disposition. Research assistants used a purposefully designed case report form to audit the injury variable capture rate, and to review Ministry of Health (MoH) issued facility Register book recording the documentation of variables. We present descriptive statistics for hospital characteristics, patient volume, facility infrastructure, and capture rate of trauma variables. Results During the study period, 2891 (9.3%) patients presented with trauma-related complaints, 70.7% were male. Overall, the capture rate of all variables was 33.6%. Documentation was most complete for demographics 71.6%, while initial clinical condition, and details of injury were documented in 20.5 and 20.8% respectively. There was no documentation for the care prior to Emergency Unit arrival in all hospitals. 1430 (49.5%) of all trauma-related visits seen were documented in the facility Health Management Information System register submitted to the MoH. Among the cases reported in the register book, the date of EU care was correctly documented in 77% cases, age 43.6%, diagnosis 66.7%, and outcome in 38.9% cases. Among the observed procedures, initial clinical condition (28.7%), interventions at Emergency Unit (52.1%), investigations (49.0%), and disposition (62.9%) were documented in the clinical charts. Conclusions In the regional hospitals of Tanzania, there is inadequate documentation of the minimum trauma variables specified in the WHO injury data set. Reasons for this are unclear, but will need to be addressed in order to improve documentation to inform a national injury registry.
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Affiliation(s)
- Hendry R Sawe
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania. .,Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Private Bag X24 • Bellville, Cape Town, 7535, South Africa.
| | - Teri A Reynolds
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Private Bag X24 • Bellville, Cape Town, 7535, South Africa.,Department for the Management of NCDs, Disability, Violence and Injury Prevention, Integrated Health Services, World Health Organization (WHO), 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Ellen J Weber
- Emergency Department, University of California San-Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Juma A Mfinanga
- Department of Emergency Medicine, Muhimbili National Hospital, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Timothy J Coats
- Department of Cardiovascular Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Lee A Wallis
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Private Bag X24 • Bellville, Cape Town, 7535, South Africa
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Rosenkrantz L, Schuurman N, Hameed M. Trauma registry implementation and operation in low and middle income countries: A scoping review. Glob Public Health 2019; 14:1884-1897. [PMID: 31232227 DOI: 10.1080/17441692.2019.1622761] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Injury 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.
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Affiliation(s)
- Leah Rosenkrantz
- Department of Geography, Simon Fraser University , Burnaby , Canada
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University , Burnaby , Canada
| | - Morad Hameed
- Divisions of General Surgery, Vancouver General Hospital, University of British Columbia , Vancouver , Canada
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Chokotho LC, Mulwafu W, Nyirenda M, Mbomuwa FJ, Pandit HG, Le G, Lavy C. Establishment of trauma registry at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi and mapping of high risk geographic areas for trauma. World J Emerg Med 2019; 10:33-41. [PMID: 30598716 DOI: 10.5847/wjem.j.1920-8642.2019.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Less attention is directed toward gaining a better understanding of the burden and prevention of injuries, in low and middle income countries (LMICs). We report the establishment of a trauma registry at the Adult Emergency and Trauma Centre (AETC) at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi and identify high risk geographic areas. METHODS We devised a paper based two-page trauma registry form. Ten data clerks and all AETC clinicians were trained to complete demographic and clinical details respectively. Descriptive data, regression and hotspot analyses were done using STATA 15 statistical package and ArcGIS (16) software respectively. RESULTS There were 3,747 patients from May 2013 to May 2015. The most common mechanisms of injury were assault (38.2%), and road traffic injuries (31.6%). The majority had soft tissue injury (53.1%), while 23.8% had no diagnosis indicated. Fractures (OR 19.94 [15.34-25.93]), head injury and internal organ injury (OR 29.5 [16.29-53.4]), and use of ambulance (OR 1.57 [1.06-2.33]) were found to be predictive of increased odds of being admitted to hospital while assault (OR 0.69 [0.52-0.91]) was found to be associated with less odds of being admitted to hospital. Hot spot analysis showed that at 99% confidence interval, Ndirande, Mbayani and Limbe were the top hot spots for injury occurrence. CONCLUSION We have described the process of establishing an integrated and potentially sustainable trauma registry. Significant data were captured to provide details on the epidemiology of trauma and insight on how care could be improved at AETC and surrounding health facilities. This approach may be relevant in similar poor resource settings.
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Affiliation(s)
| | - Wakisa Mulwafu
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mulinda Nyirenda
- Adult Emergency and Trauma Center, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi
| | | | | | - Grace Le
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christopher Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Hewitt-Smith A, Bulamba F, Olupot C, Musana F, Ochieng JP, Lipnick MS, Pearse RM. Surgical outcomes in eastern Uganda: a one-year cohort study. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2018. [DOI: 10.1080/22201181.2018.1517476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- A Hewitt-Smith
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - F Bulamba
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - C Olupot
- Mbale Regional Referral Hospital, Mbale, Uganda
| | - F Musana
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - JP Ochieng
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - MS Lipnick
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - RM Pearse
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Mehmood A, Zia N, Hoe C, Kobusingye O, Ssenyojo H, Hyder AA. Traumatic brain injury in Uganda: exploring the use of a hospital based registry for measuring burden and outcomes. BMC Res Notes 2018; 11:299. [PMID: 29764476 PMCID: PMC5952367 DOI: 10.1186/s13104-018-3419-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/09/2018] [Indexed: 12/03/2022] Open
Abstract
Objective Lack of data on traumatic brain injuries (TBI) hinders the appreciation of the true magnitude of the TBI burden. This paper describes a scientific approach for hospital based systematic data collection in a low-income country. The registry is based on the evaluation framework for injury surveillance systems which comprises a four-step approach: (1) identifying characteristics that assess a surveillance system, (2) review of the identified variables based on adopted specific, measurable, assignable, realistic, and time-related criteria, (3) assessment of the proposed variables and system characteristics by an expert panel, and (4) development and application of a rating system. Results The electronic hospital-based TBI registry is designed through a collaborative approach to capture comprehensive, yet context specific, information on each TBI case, from the time of injury until death or discharge from the hospital. It includes patients’ demographics, pre-hospital and hospital assessment and care, TBI causes, injury severity, and patient outcomes. The registry in Uganda will open the opportunity to replicate the process in other similar context and contribute to a better understanding of TBI in these settings, and feed into the global agenda of reducing deaths and disabilities from TBI in low-and middle-income countries. Electronic supplementary material The online version of this article (10.1186/s13104-018-3419-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amber Mehmood
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Connie Hoe
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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20
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Presenting an evaluation model of the trauma registry software. Int J Med Inform 2018; 112:99-103. [DOI: 10.1016/j.ijmedinf.2018.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/19/2022]
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Bommakanti K, Feldhaus I, Motwani G, Dicker RA, Juillard C. Trauma registry implementation in low- and middle-income countries: challenges and opportunities. J Surg Res 2018; 223:72-86. [DOI: 10.1016/j.jss.2017.09.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/07/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
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Mulwafu W, Chokotho L, Mkandawire N, Pandit H, Deckelbaum DL, Lavy C, Jacobsen KH. Trauma care in Malawi: A call to action. Malawi Med J 2018; 29:198-202. [PMID: 28955433 PMCID: PMC5610296 DOI: 10.4314/mmj.v29i2.23] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Injuries are a global public health concern because most are preventable yet they continue to be a major cause of death and disability, especially among children, adolescents, and young adults. This enormous loss of human potential has numerous negative social and economic consequences. Malawi has no formal system of prehospital trauma care, and there is limited access to hospital-based trauma care, orthopaedic surgery, and rehabilitation. While some hospitals and research teams have established local trauma registries and quantified the burden of injuries in parts of Malawi, there is no national injury surveillance database compiling the data needed in order to develop and implement evidence-based prevention initiatives and guidelines to improve the quality of clinical care. Studies in other low- and middle-income countries (LMICs) have demonstrated cost-effective methods for enhancing prehospital, in-hospital, and post-discharge care of trauma patients. We encourage health sectors leaders from across Malawi to take action to improve trauma care and reduce the burden from injury in this country.
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Affiliation(s)
- Wakisa Mulwafu
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Nyengo Mkandawire
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Dan L Deckelbaum
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; University of Oxford, Oxford, United Kindgom
| | - Kathryn H Jacobsen
- Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
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23
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Plastic and Reconstructive Surgery in Global Health: Let's Reconstruct Global Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1273. [PMID: 28507847 PMCID: PMC5426866 DOI: 10.1097/gox.0000000000001273] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/27/2017] [Indexed: 11/25/2022]
Abstract
Since the inception of the Lancet Commission in 2013 and consequent prioritization of Global Surgery at the World Health Assembly, international surgical outreach efforts have increased and become more synergistic. Plastic surgeons have been involved in international outreach for decades, and there is now a demand to collaborate and address local need in an innovative way. The aim of this article was to summarize new developments in plastic and reconstructive surgery in global health, to unify our approach to international outreach. Specifically, 5 topics are explored: current models in international outreach, benefits and concerns, the value of research, the value of international surgical outreach education, and the value of technology. A “Let’s Reconstruct Global Surgery” network has been formed using Facebook as a platform to unite plastic and reconstructive surgeons worldwide who are interested in international outreach. The article concludes with actionable recommendations from each topic.
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Botchey IM, Hung YW, Bachani AM, Saidi H, Paruk F, Hyder AA. Understanding patterns of injury in Kenya: Analysis of a trauma registry data from a National Referral Hospital. Surgery 2017; 162:S54-S62. [PMID: 28438334 DOI: 10.1016/j.surg.2017.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Injuries contribute to a substantial proportion of the burden of disease in Kenya. Trauma registries can be a very useful source of data to understand patterns of injuries and serve to provide information about potential improvements in the care of injured patients. In Kenya, health facility-based injury data has been largely administrative. Our aim was to develop and implement a prospective trauma registry at the largest trauma hospital in Kenya, the Kenyatta National Hospital, and to understand the nature of injuries presenting to the hospital, their treatment and care, and their outcomes. METHODS An electronic, tablet-based instrument was developed and implemented between January 2014 and June 2015. Data were collected at the emergency department, and patients were followed through disposition from the emergency department or in-patient wards if admitted. Variables included demographics, type of prehospital care received, details of the injury, and initial assessment and disposition from the emergency department or in-patient wards. Bivariate and multiple logistic regressions were used to assess potential risk factors associated with outcomes. RESULTS A total of 8,701 injury patients were included in the registry during the study period. The mean age of the injured patients was 28 years (standard deviation, 26 years). The majority of these patients were males (81.7%). The leading mechanisms of injuries were road traffic injury (41.7%), assault (25.3%), and falls (18.9%). Only 7.4% of patients received prehospital care; 49.6% of injured patients arrived within 1 hour after their injury. Hospital mortality was 4.4% and close to 1% of patients died in the emergency department. The independent predictors of in-hospital death were older age (≥60 years), injury mechanism (burns and road traffic injuries), and admission type (transfer) after controlling for injury severity. CONCLUSION The establishment of hospital-based trauma registries can be an important tool for injury surveillance. This information will facilitate identifying priority areas for trauma care and quality improvement, as well as guiding the development of injury prevention and control programs.
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Affiliation(s)
- Isaac M Botchey
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yuen Wai Hung
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hassan Saidi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Fatima Paruk
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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25
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Laytin AD, Dicker RA, Gerdin M, Roy N, Sarang B, Kumar V, Juillard C. Comparing traditional and novel injury scoring systems in a US level-I trauma center: an opportunity for improved injury surveillance in low- and middle-income countries. J Surg Res 2017; 215:60-66. [PMID: 28688663 DOI: 10.1016/j.jss.2017.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/03/2017] [Accepted: 03/24/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND In most low- and middle-income countries (LMICs), the resources to accurately quantify injury severity using traditional injury scoring systems are limited. Novel injury scoring systems appear to have adequate discrimination for mortality in LMIC contexts, but they have not been rigorously compared where traditional injury scores can be accurately calculated. To determine whether novel injury scoring systems perform as well as traditional ones in a HIC with complete and comprehensive data collection. METHODS Data from an American level-I trauma registry collected 2008-2013 were used to compare three traditional injury scoring systems: Injury Severity Score (ISS); Revised Trauma Score (RTS); and Trauma Injury Severity Score (TRISS); and three novel injury scoring systems: Kampala Trauma Score (KTS); Mechanism, GCS, Age and Pressure (MGAP) score; and GCS, Age and Pressure (GAP) score. Logistic regression was used to assess the association between each scoring system and mortality. Standardized regression coefficients (β2), Akaike information criteria, area under the receiver operating characteristics curve, and the calibration line intercept and slope were used to evaluate the discrimination and calibration of each model. RESULTS Among 18,746 patients, all six scores were associated with hospital mortality. GAP had the highest effect size, and KTS had the lowest median Akaike information criteria. Although TRISS discriminated best, the discrimination of KTS approached that of TRISS and outperformed GAP, MGAP, RTS, and ISS. MGAP was best calibrated, and KTS was better calibrated than RTS, GAP, ISS, or TRISS. CONCLUSIONS The novel injury scoring systems (KTS, MGAP, and GAP), which are more feasible to calculate in low-resource settings, discriminated hospital mortality as well as traditional injury scoring systems (ISS and RTS) and approached the discrimination of a sophisticated, data-intensive injury scoring system (TRISS) in a high-resource setting. Two novel injury scoring systems (KTS and MGAP) surpassed the calibration of TRISS. These novel injury scoring systems should be considered when clinicians and researchers wish to accurately account for injury severity. Implementation of these resource-appropriate tools in LMICs can improve injury surveillance, guiding quality improvement efforts, and supporting advocacy for resource allocation commensurate with the volume and severity of trauma.
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Affiliation(s)
- Adam D Laytin
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, California
| | - Rochelle A Dicker
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, California
| | - Martin Gerdin
- Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Nobhojit Roy
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, California; Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, BARC Hospital (Govt of India), Mumbai, India
| | - Bhakti Sarang
- Department of Surgery, BARC Hospital (Govt of India), Mumbai, India
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Catherine Juillard
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, California.
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Mehmood A, Allen KA, Al-Maniri A, Al-Kashmiri A, Al-Yazidi M, Hyder AA. Trauma care in Oman: A call for action. Surgery 2017; 162:S107-S116. [PMID: 28351526 DOI: 10.1016/j.surg.2017.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 11/17/2022]
Abstract
Many Arab countries have undergone the epidemiologic transition of diseases with increasing economic development and a proportionately decreasing prevalence of communicable diseases. With this transition, injuries have emerged as a major cause of mortality and morbidity in the Gulf Cooperation Council countries in addition to diseases of affluence. Injuries are the number one cause of years of life lost and disability-adjusted life-years in the Sultanate of Oman. The burden of injuries, which affects mostly young Omani males, has a unique geographic distribution that is in contrast to the trauma care capabilities of the country. The concentration of health care resources in the northern part of the country makes it difficult for the majority of Omanis who live elsewhere to access high-quality and time-sensitive care. A broader multisectorial national injury prevention strategy should be evidence based and must strengthen human resources, service delivery, and information systems to improve care of the injured and loss of life. This paper provides a unique overview of the Omani health system with the goal of examining its trauma care capabilities and injury control policies.
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Affiliation(s)
- Amber Mehmood
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Katharine A Allen
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Development of Synthetic Microbial Platforms to Convert Lignocellulosic Biomass to Biofuels. ADVANCES IN BIOENERGY 2017. [DOI: 10.1016/bs.aibe.2016.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Mehmood A, Chan E, Allen K, Al-Kashmiri A, Al-Busaidi A, Al-Abri J, Al-Yazidi M, Al-Maniri A, Hyder AA. Development of an mHealth trauma registry in the Middle East using an implementation science framework. Glob Health Action 2017; 10:1380360. [PMID: 29027507 PMCID: PMC5678440 DOI: 10.1080/16549716.2017.1380360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Trauma registries (TRs) play a vital role in the assessment of trauma care, but are often underutilized in countries with a high burden of injuries. OBJECTIVES We investigated whether information and communications technology (ICT) such as mobile health (mHealth) could enable the design of a tablet-based application for healthcare professionals. This would be used to inform trauma care and acquire surveillance data for injury control and prevention in Oman. This paper focuses on documenting the implementation process in a healthcare setting. METHODS The study was conducted using an ICT implementation framework consisting of multistep assessment, development and pilot testing of an electronic tablet-based TR. The pilot study was conducted at two large hospitals in Oman, followed by detailed evaluation of the process, system and impact of implementation. RESULTS The registry was designed to provide comprehensive information on each trauma case from the location of injury until hospital discharge, with variables organized to cover 11 domains of demographic and clinical information. The pilot study demonstrated that the registry was user friendly and reliable, and the implementation framework was useful in planning for the Omani hospital setting. Data collection by trained and dedicated nurses proved to be more feasible, efficient and reliable than real-time data entry by care providers. CONCLUSIONS The initial results show the promising potential of a user-friendly, comprehensive electronic TR through the use of mHealth tools. The pilot test in two hospitals indicates that the registry can be used to create a multicenter trauma database.
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Affiliation(s)
- Amber Mehmood
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edward Chan
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katharine Allen
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | - Adnan A. Hyder
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Li Q, Alonge O, Hyder AA. Children and road traffic injuries: can't the world do better? Arch Dis Child 2016; 101:1063-1070. [PMID: 27543508 DOI: 10.1136/archdischild-2015-309586] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/19/2016] [Accepted: 07/22/2016] [Indexed: 11/03/2022]
Abstract
Road traffic injuries (RTI) impose a substantial health burden among children. Globally, 186 300 children (under 18 years) die from RTI each year. It is the fourth leading cause of death among children aged 5-9 years, third among children aged 10-14 years and first among children aged 15-17 years. At the regional level, sub-Saharan Africa accounts for 35.2% of global child deaths caused by RTI; that number is still increasing. Male children are about two times more likely to die due to RTI than female children. RTI are also related to socioeconomic inequalities; low-income and middle-income countries (LMIC) account for 95% of global child RTI deaths, and children from poor households are more likely to fall victims to RTI. Intervention strategies promoted in the five pillars of the Decade of Action for Road Safety 2011-2020 are available to prevent mortality and morbidity caused by RTI, though validation and implementation of such interventions are urgently needed in the LMIC. Through concerted efforts to cultivate strong political will, build action and advocacy capacity, increase global funding and enhance multisectoral collaboration promoted by the Sustainable Development Goals, the world is challenged to do better in saving children from RTI.
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Affiliation(s)
- Qingfeng Li
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Olakunle Alonge
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Khoshmohabat H, Rasouli HR, Danial Z, Ghane MR. Validation of an Iranian Trauma Data Collection Form. Trauma Mon 2016; 21:e24686. [PMID: 29992126 PMCID: PMC5958951 DOI: 10.5812/traumamon.24686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 08/31/2015] [Accepted: 10/11/2015] [Indexed: 12/04/2022] Open
Abstract
Background Knowing the direction of traumatic injury is important as the information can help avoid death after trauma. A trauma registry usually entails detailed information about the demographics, cause, intensity of the injury, and the final diagnosis and outcome of the trauma-affected patient. Researchers should be able to evaluate all aspects of trauma injury and the patient’s status. Objectives The purpose of this study was to develop a trauma data collection form. Materials and Methods The development of the trauma registry form began in February 2013. The variables were finalized by a team consisting of general and trauma surgeons, specialists in emergency medicine, orthopedists, neurosurgeons, and public health professionals who have special interest in trauma research. The scale was sent to 10 specialists for validation. Results After assessing the scale validity twice, it was accepted with an integrator agreement of 0.89. The test-retest reliability was assessed in a convenience sample of 20 physicians (Kendall t = 0.97; P < 0.001). Such a high reliability may reflect redundancy of some items. Conclusions It is essential to establish a secure multicenter trauma registry in Iran for data collection, storage, and assessment of traumatic injury and these registries must be easy to install and use.
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Affiliation(s)
- Hadi Khoshmohabat
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hamid Reza Rasouli
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Zahra Danial
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Ghane
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Reza Ghane, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188053766, Fax: +98-2188053766, E-mail:
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Shah AA, Latif A, Zogg CK, Zafar SN, Riviello R, Halim MS, Rehman Z, Haider AH, Zafar H. Emergency general surgery in a low-middle income health care setting: Determinants of outcomes. Surgery 2016; 159:641-9. [PMID: 26361098 DOI: 10.1016/j.surg.2015.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/26/2015] [Accepted: 08/01/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Emergency general surgery (EGS) has emerged as an important component of frontline operative care. Efforts in high-income settings have described its burden but have yet to consider low- and middle-income health care settings in which emergent conditions represent a high proportion of operative need. The objective of this study was to describe the disease spectrum of EGS conditions and associated factors among patients presenting in a low-middle income context. METHODS March 2009-April 2014 discharge data from a university teaching hospital in South Asia were obtained for patients (≥16 years) with primary International Classification of Diseases, 9(th) revision, Clinical Modification diagnosis codes consistent with an EGS condition as defined by the American Association for the Surgery of Trauma. Outcomes included in-hospital mortality and occurrence of ≥1 major complication(s). Multivariable analyses were performed, adjusting for differences in demographic and case-mix factors. RESULTS A total of 13,893 discharge records corresponded to EGS conditions. Average age was 47.2 years (±16.8, standard deviation), with a male preponderance (59.9%). The majority presented with admitting diagnoses of biliary disease (20.2%), followed by soft-tissue disorders (15.7%), hernias (14.9%), and colorectal disease (14.3%). Rates of death and complications were 2.7% and 6.6%, respectively; increasing age was an independent predictor of both. Patients in need of resuscitation (n = 225) had the greatest rates of mortality (72.9%) and complications (94.2%). CONCLUSION This study takes an important step toward quantifying outcomes and complications of EGS, providing one of the first assessments of EGS conditions using American Association for the Surgery of Trauma definitions in a low-middle income health care setting. Further efforts in varied settings are needed to promote representative benchmarking worldwide.
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Affiliation(s)
- Adil A Shah
- Department of Surgery, The Aga Khan University, Karachi, Pakistan; Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Asad Latif
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Syed Nabeel Zafar
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Robert Riviello
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Muhammad Sohail Halim
- Section of Critical Care, Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Zia Rehman
- Department of Surgery, The Aga Khan University, Karachi, Pakistan
| | - Adil H Haider
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
| | - Hasnain Zafar
- Department of Surgery, The Aga Khan University, Karachi, Pakistan
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O'Reilly GM, Gabbe B, Braaf S, Cameron PA. An interview of trauma registry custodians to determine lessons learnt. Injury 2016; 47:116-24. [PMID: 26190630 DOI: 10.1016/j.injury.2015.06.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The international burden of injury is an increasing concern in global healthcare. Developed trauma care systems have reduced death and disability following injury. The ideal platform for surveillance and clinical governance in trauma care quality improvement is the trauma registry. There is a great disparity in the prevalence of active trauma registries between developed and developing countries. More detailed information on lessons learnt would guide those settings, hospitals and regions looking to establish a sustainable trauma registry. The aim of this study was to explore the experiences and perceptions of trauma registry custodians regarding the development of successful and sustainable trauma registries. METHODS This was a qualitative study using semi-structured interviews of trauma registry custodians. Trauma registries were selected from a wide range of jurisdictions, including single hospital and multi-hospital registries, based in developed and developing countries. Interview transcripts were analysed using thematic analysis; recurrent themes were identified, and a coding frame developed. Quotes were identified to illustrate the themes in the participants' own words. RESULTS Twenty-seven interviews, representing 29 registries, were completed. Fourteen of the source registries were based in developed countries (6 single hospital, 8 multi-hospital) and 15 were based in developing countries (9 single hospital, 6 multi-hospital). The analysis generated 15 themes covering resources, data and strategies. The themes dealing with resources were: funding, staffing, information technology and tools for guidance. The themes dealing with data were: data quality, simplicity, injury coding and data utilisation. The themes dealing with strategies were: having a local champion and a clear purpose, stakeholder buy-in, governance, integration, getting started and persistence. For developing countries, the need for a local champion, dealing with data quality through prospective data collection, integration into local resources and keeping it simple were considered particularly important. CONCLUSION The general consensus was that, for a trauma registry to be successful, in addition to adequate funding and trained staff, it needs to be led by a local champion with engagement of key local stakeholders. It should have a clear purpose, pay close attention to data quality and ensure that the data is well used.
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Affiliation(s)
- Gerard M O'Reilly
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Commercial Rd, Melbourne 3004, Australia; Emergency and Trauma Centre, Alfred Health, Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Commercial Rd, Melbourne 3004, Australia
| | - Sandra Braaf
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Commercial Rd, Melbourne 3004, Australia
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Commercial Rd, Melbourne 3004, Australia; Emergency and Trauma Centre, Alfred Health, Commercial Rd, Melbourne, Victoria 3004, Australia; Emergency Services, Hamad Medical Corporation, Doha, Qatar
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Hanche-Olsen TP, Alemu L, Viste A, Wisborg T, Hansen KS. Evaluation of training program for surgical trauma teams in Botswana. World J Surg 2015; 39:658-68. [PMID: 25413178 DOI: 10.1007/s00268-014-2873-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trauma represents a challenge to healthcare systems worldwide, particularly in low-and middle-income countries. Positive effects can be achieved by improving trauma care at the scene of the accident and throughout hospitalization and rehabilitation. Therefore, we assessed the long-term effects of national implementation of a training program for multidisciplinary trauma teams in a southern African country. METHODS From 2007 to 2009, an educational program for trauma, "Better and Systematic Team Training," (BEST) was implemented at all government hospitals in Botswana. The effects were assessed through interviews, a structured questionnaire, and physical inspections using the World Health Organization's "Guidelines for Essential Trauma Care." Data on human and physical resources, infrastructure, trauma administrative functions, and quality-improvement activities before and at 2-year follow-up were compared for all 27 government hospitals. RESULTS A majority of hospitals had formed local trauma organizations; half were performing multidisciplinary trauma simulations and some had organized multidisciplinary trauma teams with alarm criteria. A number of hospitals had developed local trauma guidelines and local trauma registries. More equipment for advanced airway management and stiff cervical collars were available after 2 years. There were also improvements in the skills necessary for airway and breathing management. The most changes were seen in the northern region of Botswana. CONCLUSIONS Implementation of BEST in Botswana hospitals was associated with several positive changes at 2-year follow-up, particularly for trauma administrative functions and quality-improvement activities. The effects on obtaining technical equipment and skills were moderate and related mostly to airway and breathing management.
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Boughton O, Jones GG, Lavy CBD, Grimes CE. Young, male, road traffic victims: a systematic review of the published trauma registry literature from low and middle income countries. SICOT J 2015; 1:10. [PMID: 27163066 PMCID: PMC4849265 DOI: 10.1051/sicotj/2015007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Christopher B D Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Oxford OX1 2JD UK
| | - Caris E Grimes
- King's Centre for Global Health, King's College London London WC2R 2LS UK
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Tran TM, Fuller AT, Kiryabwire J, Mukasa J, Muhumuza M, Ssenyojo H, Haglund MM. Distribution and Characteristics of Severe Traumatic Brain Injury at Mulago National Referral Hospital in Uganda. World Neurosurg 2015; 83:269-77. [DOI: 10.1016/j.wneu.2014.12.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
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Development, implementation, and evaluation of a hybrid electronic medical record system specifically designed for a developing world surgical service. World J Surg 2015; 38:1388-97. [PMID: 24378554 DOI: 10.1007/s00268-013-2438-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Pietermaritzburg Metropolitan Trauma Service previously successfully constructed and implemented an electronic surgical registry (ESR). This study reports on our attempts to expand and develop this concept into a multi-functional hybrid electronic medical record (HEMR) system for use in a tertiary level surgical service. This HEMR system was designed to incorporate the function and benefits of an ESR, an electronic medical record (EMR) system, and a clinical decision support system (CDSS). METHODS Formal ethical approval to maintain the HEMR system was obtained. Appropriate software was sourced to develop the project. The data model was designed as a relational database. Following the design and construction process, the HEMR file was launched on a secure server. This provided the benefits of access security and automated backups. A systematic training program was implemented for client training. The exercise of data capture was integrated into the process of clinical workflow, taking place at multiple points in time. Data were captured at the times of admission, operative intervention, endoscopic intervention, adverse events (morbidity), and the end of patient care (discharge, transfer, or death). RESULTS A quarterly audit was performed 3 months after implementation of the HEMR system. The data were extracted and audited to assess their quality. A total of 1,114 patient entries were captured in the system. Compliance rates were in the order of 87-100 %, and client satisfaction rates were high. CONCLUSIONS It is possible to construct and implement a unique, simple, cost-effective HEMR system in a developing world surgical service. This information system is unique in that it combines the discrete functions of an EMR system with an ESR and a CDSS. We identified a number of potential limitations and developed interventions to ameliorate them. This HEMR system provides the necessary platform for ongoing quality improvement programs and clinical research.
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Carreiro PRL, Drumond DAF, Starling SV, Moritz M, Ladeira RM. Implementation of a trauma registry in a brazilian public hospital: the first 1,000 patients. Rev Col Bras Cir 2014; 41:251-5. [DOI: 10.1590/0100-69912014004005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/12/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database.METHODS: 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.RESULTS: 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%.CONCLUSION: 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.
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Alghnam S, Alkelya M, Al-Bedah K, Al-Enazi S. Burden of traumatic injuries in Saudi Arabia: lessons from a major trauma registry in Riyadh, Saudi Arabia. Ann Saudi Med 2014; 34:291-6. [PMID: 25811200 PMCID: PMC6152567 DOI: 10.5144/0256-4947.2014.291] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In Saudi Arabia (SA), injuries are the second leading cause of death; however, little is known about their frequencies and outcomes. Trauma registries play a major role in measuring the burden on population health. This study aims to describe the population of the only hospital-based trauma registry in the country and highlight challenges and potential opportunities to improve trauma data collection and research in SA. DESIGN AND SETTINGS Using data between 2001 and 2010, this retrospective study included patients from a large trauma center in Riyadh, SA. PATIENTS AND METHODS A staff nurse utilized a structured checklist to gather information on patients' demographic, physiologic, anatomic, and outcome variables. Basic descriptive statistics by age group ( 14 years) were calculated, and differences were assessed using student t and chi-square tests. In addition, the mechanism of injury and the frequency of missing data were evaluated. RESULTS 10 847 patients from the trauma registry were included. Over 9% of all patients died either before or after being treated at the hospital. Patients who were older than 14 years of age (more likely to be male) sustained traffic-related injuries and died in the hospital as compared to patients who were younger than or equal to years of age. Deceased patients were severely injured as measured by injury severity score and Glasgow Coma Scale (P < .001). Overall, the most frequent type of injury was related to traffic (52.0%), followed by falls (23.4%). Missing values were mostly prevalent in traffic-related variables, such as seatbelt use (70.2%). CONCLUSION This registry is a key step toward addressing the burden of injuries in SA. Improved injury classification using the International Classification of Disease-external cause codes may improve the quality of the registry and allow comparison with other populations. Most importantly, injury prevention in SA requires further investment in data collection and research to improve outcomes.
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Affiliation(s)
- Suliman Alghnam
- Dr. Suliman Alghnam, King Abdullah International Research Center (KAIMRC) Population Health, PO Box 22490 Riyadh 11426 Saudi Arabia, T: 966566639414,
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Laing GL, Bruce JL, Aldous C, Clarke DL. The design, construction and implementation of a computerised trauma registry in a developing South African metropolitan trauma service. Injury 2014; 45:3-8. [PMID: 23827395 DOI: 10.1016/j.injury.2013.05.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Pietermaritzburg Metropolitan Trauma Service formerly lacked a robust computerised trauma registry. This made surgical audit difficult for the purpose of quality of care improvement and development. We aimed to design, construct and implement a computerised trauma registry within our service. Twelve months following its implementation, we sought to examine and report on the quality of the registry. METHODOLOGY Formal ethical approval to maintain a computerised trauma registry was obtained prior to undertaking any design and development. Appropriate commercial software was sourced to develop this project. The registry was designed as a flat file. A flat file is a plain text or mixed text and binary file which usually contains one record per line or physical record. Thereafter the registry file was launched onto a secure server. This provided the benefits of access security and automated backups. Registry training was provided to clients by the developer. The exercise of data capture was then integrated into the process of service delivery, taking place at the endpoint of patient care (discharge, transfer or death). Twelve months following its implementation, the compliance rates of data entry were measured. RESULTS The developer of this project managed to design, construct and implement an electronic trauma registry into the service. Twelve months following its implementation the data were extracted and audited to assess the quality. A total of 2640 patient entries were captured onto the registry. Compliance rates were in the order of eighty percent and client satisfaction rates were high. A number of deficits were identified. These included the omission of weekend discharges and underreporting of deaths. CONCLUSION The construction and implementation of the computerised trauma registry was the beginning of an endeavour to continue improvements in the quality of care within our service. The registry provided a reliable audit at twelve months post implementation. Deficits and limitations were identified and new strategies have been planned to overcome these problems and integrate the trauma registry into the process of clinical care.
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Affiliation(s)
- G L Laing
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, Department of General Surgery, University of KwaZulu-Natal Nelson R Mandela School of Medicine, South Africa.
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