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Pivetta LGA, Antunes PDESL, Shimoda GM, Parreira JG, Perlingeiro JAG, Assef JC. Trauma Registry: Trauma Quality indicators analysis in hospitalized patients. Rev Col Bras Cir 2024; 51:e20243604. [PMID: 38597571 PMCID: PMC11185059 DOI: 10.1590/0100-6991e-20243604-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/04/2023] [Indexed: 04/11/2024] Open
Abstract
PURPOSE to consolidate a Trauma Register (TR) trough REDCap data acquisition platform and to validate, in this context, local Quality Indicators (QI) as improvement opportunities in trauma management. METHODS continuous data acquisition of all patients admitted in Irmandade da Santa Casa de Misericórdia de São Paulo adult Trauma bay and it's validation in REDCap platform; 6 months retrospective cohort of QI impact in length of hospitalar stay, complications and mortality. Fisher, Chi-squared, Wilcoxon and Kruskal-Wallis tests were used to correlate QIs fails with the endpoints, considering p<0.05 and CI <95% as statically significant. RESULTS 465 were admitted in Trauma bay, with 137 patients hospitalized (29.5%); the number of QIs compromised were related with more complications (p=0.075) and increased length of stay (p=0.028), especially the delay in open fracture's surgical management, which increased the severe complications' incidence (p=0.005). CONCLUSION the REDCap data acquisition platform is useful as a tool for multi center TR implementation, from ethical and logistical point of view; nevertheless, the proposed QIs are validated as attention points in trauma management, allowing improvements in traumatized patients treatment.
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Affiliation(s)
| | | | | | - José Gustavo Parreira
- Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | | | - Jose Cesar Assef
- Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
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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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Below C, Brianti IC, Parreira JG, Lucarelli-Antunes PDES, Saade N, Golin M, Pivetta LGA, Veiga JCE, Assef JC. Clinical assessment of head injuries in motorcyclists involved in traffic accidents: A prospective, observational study. Rev Col Bras Cir 2022; 49:e20223340. [PMID: 35894390 PMCID: PMC10578845 DOI: 10.1590/0100-6991e-20223340-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to review the clinical assessment of head injuries in motorcyclists involved in traffic accidents. METHOD prospective observational study, including adult motorcyclists involved in traffic accidents in a period of 12 months. Patients sustaining signs of intoxication were excluded. A modification of the Canadian Head CT Rules was used to indicate computed tomography (CT). Patients not undergoing CT were followed by phone calls for three months. Collected variables were compared between the group sustaining head injuries and the others. We used chi-square, Fisher, and Student's t for statistical analysis, considering p<0.05 as significant. RESULTS we included 208 patients, 99.0% were wearing helmets. Seventeen sustained signs of intoxication and were excluded. Ninety (47.1%) underwent CT and 12 (6.3%) sustained head injuries. Head injuries were significantly associated with Glasgow Coma Scale<15 (52.3% vs. 2.8% - p<0,001) and a positive physical exam (17.1% vs. zero - p<0,05). Four (2.1%) patients with intracranial mass lesions needed surgical interventions. None helmet-wearing patients admitted with GCS=15 and normal physical examination sustained head injuries. CONCLUSION Head CT is not necessary for helmet-wearing motorcyclists admitted with GCS=15 and normal physical examination.
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Affiliation(s)
- Cristiano Below
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | - Isabela Campos Brianti
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | - José Gustavo Parreira
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | - Pedro DE Souza Lucarelli-Antunes
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | - Nelson Saade
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | - Murilo Golin
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | | | - José Carlos Esteves Veiga
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | - Jose Cesar Assef
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
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BELOW CRISTIANO, BRIANTI ISABELACAMPOS, PARREIRA JOSÉGUSTAVO, LUCARELLI-ANTUNES PEDRODESOUZA, SAADE NELSON, GOLIN MURILO, PIVETTA LUCAGIOVANNIANTONIO, VEIGA JOSÉCARLOSESTEVES, ASSEF JOSECESAR. Investigação da presença de lesões traumáticas em segmento cefálico em motociclistas vítimas de acidentes de tráfego: Estudo observacional prospectivo. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: análise crítica da investigação diagnóstica de lesões em segmento cefálico de motociclistas vítimas de acidentes de tráfego. Método: estudo observacional prospectivo incluindo motociclistas adultos vítimas de trauma, sem intoxicação exógena, em um período de 12 meses. A tomografia de crânio (TC) foi indicada de acordo com uma modificação dos “critérios canadenses”. Os pacientes que não foram submetidos a TC de crânio tiveram acompanhamento telefônico por três meses. A presença de lesões foi correlacionada com as varáveis coletadas através dos testes Qui-quadrado, t de Student ou Fisher, considerando p<0,05 como significativo. Resultados: dos 208 inicialmente incluídos, 206 (99,0%) estavam usando capacete. Dezessete estavam com sinais de intoxicação exógena e foram excluídos, restando 191 para análise. Noventa pacientes (47,1%) realizaram TC e 12 (6,3%) apresentaram lesões craniencefálicas, que se associaram significativamente a Escala de Coma de Glasgow (ECG) <15 (52,3% vs. 2,8% - p<0,001) e alterações ao exame físico da região cefálica/neurológico (17,1% vs. zero - p<0,05). Quatro pacientes (2,1%) precisaram tratamento cirúrgico de lesões intracranianas. Nenhum dos pacientes admitidos com ECG 15, em uso de capacete e sem alterações no exame físico apresentou TC alterada. Conclusões: para pacientes admitidos com ECG 15, que utilizavam o capacete no acidente e não apresentavam quaisquer alterações no exame físico, a realização da TC de crânio não trouxe mudanças no atendimento ao paciente. .
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Affiliation(s)
- CRISTIANO BELOW
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
| | | | - JOSÉ GUSTAVO PARREIRA
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
| | | | - NELSON SAADE
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
| | - MURILO GOLIN
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
| | | | - JOSÉ CARLOS ESTEVES VEIGA
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
| | - JOSE CESAR ASSEF
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
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Barriers to Trauma Care in South and Central America: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1163-1177. [PMID: 34392445 PMCID: PMC9279262 DOI: 10.1007/s00590-021-03080-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
Introduction Trauma is widespread in Central and South America and is a significant cause of morbidity and mortality. Providing high quality emergency trauma care is of great importance. Understanding the barriers to care is challenging; this systematic review aims to establish current the current challenges and barriers in providing high-quality trauma care within the 21 countries in the region. Methods OVID Medline, Embase, EBM reviews and Global Health databases were systematically searched in October 2020. Records were screened by two independent researchers. Data were extracted according to a predetermined proforma. Studies of any type, published in the preceding decade were included, excluding grey literature and non-English records. Trauma was defined as blunt or penetrating injury from an external force. Studies were individually critically appraised and assessed for bias using the RTI item bank. Results 57 records met the inclusion criteria. 20 countries were covered at least once. Nine key barriers were identified: training (37/57), resources and equipment (33/57), protocols (29/57), staffing (17/57), transport and logistics (16/57), finance (15/57), socio-cultural (13/57), capacity (9/57), public education (4/57). Conclusion Nine key barriers negatively impact on the provision of high-quality trauma care and highlight potential areas for improving care in Central & South America. Many countries in the region, along with rural areas, are under-represented by the current literature and future research is urgently required to assess barriers to trauma management in these countries. No funding was received. Clinical Trial Registration: PROSPERO CRD42020220380.
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Eboreime EA, Abimbola S. A priori registration of global health research-necessity or absurdity? BMJ Glob Health 2021; 6:e006199. [PMID: 34001522 PMCID: PMC8130736 DOI: 10.1136/bmjgh-2021-006199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- Ejemai Amaize Eboreime
- Department of Planning, Research & Statistics, National Primary Health Care Development Agency, Abuja, FCT, Nigeria
- Global Mental Health Research Group, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Julius Global Health, University Medical Center, Utrecht University, Utrecht, The Netherlands
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Antunes PDESL, LibÓrio PR, Shimoda GM, Pivetta LGA, Parreira JG, Assef JC. Trauma Quality Indicators' usage limitations in severe trauma patients. Rev Col Bras Cir 2021; 48:e20202769. [PMID: 33656134 PMCID: PMC10683457 DOI: 10.1590/0100-6991e-20202769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE to analyze the relation between Trauma Quality Indicators (QI) and death, as well as clinical adverse events in severe trauma patients. METHODS analysis of data collected in the Trauma Register between 2014-2015, including patients with Injury Severity Score (ISS) > 16, reviewing the QI: (F1) Acute subdural hematoma drainage > 4 hours with Glasgow Coma Scale (GCS) <9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours; (F4) Admission-laparotomy time greater than 60 min in hemodynamically instable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time > 6 hours; (F10) Surgery > 24 hours. T the chi-squared and Fisher tests were used to calculate statistical relevance, considering p<0.05 as relevant. RESULTS 127 patients were included, whose ISS ranged from 17 to 75 (28.8 + 11.5). There were adverse events in 80 cases (63%) and 29 died (22.8%). Twenty-six patients had some QI compromised (20.6%). From the 101 patients with no QI, 22% died, and 7 of 26 patients with compromised QI (26.9%) (p=0.595). From the patients with no compromised QI, 62% presented some adverse event. From the patients with any compromised QI, 18 (65.4%) had some adverse event on clinical evolution (p=0.751). CONCLUSION the QI should not be used as death or adverse events predictors in severe trauma patients.
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Affiliation(s)
| | - Paula Ribeiro LibÓrio
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Disciplina de Cirurgia - São Paulo - SP - Brasil
| | - Giovanna Mennitti Shimoda
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Disciplina de Cirurgia - São Paulo - SP - Brasil
| | | | - JosÉ Gustavo Parreira
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Disciplina de Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | - Jose Cesar Assef
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Disciplina de Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
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Dasari M, Johnson ED, Montenegro JH, Griswold DP, Jiménez MF, Puyana JC, Rubiano AM. A consensus statement for trauma surgery capacity building in Latin America. World J Emerg Surg 2021; 16:4. [PMID: 33516227 PMCID: PMC7847173 DOI: 10.1186/s13017-021-00347-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/18/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Trauma is a significant public health problem in Latin America (LA), contributing to substantial death and disability in the region. Several LA countries have implemented trauma registries and injury surveillance systems. However, the region lacks an integrated trauma system. The consensus conference's goal was to integrate existing LA trauma data collection efforts into a regional trauma program and encourage the use of the data to inform health policy. METHODS We created a consensus group of 25 experts in trauma and emergency care with previous data collection and injury surveillance experience in the LA. region. Experts participated in a consensus conference to discuss the state of trauma data collection in LA. We utilized the Delphi method to build consensus around strategic steps for trauma data management in the region. Consensus was defined as the agreement of ≥ 70% among the expert panel. RESULTS The consensus conference determined that action was necessary from academic bodies, scientific societies, and ministries of health to encourage a culture of collection and use of health data in trauma. The panel developed a set of recommendations for these groups to encourage the development and use of robust trauma information systems in LA. Consensus was achieved in one Delphi round. CONCLUSIONS The expert group successfully reached a consensus on recommendations to key stakeholders in trauma information systems in LA. These recommendations may be used to encourage capacity building in trauma research and trauma health policy in the region.
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Affiliation(s)
- Mohini Dasari
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | | | | | - Dylan P. Griswold
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
- Stanford School of Medicine, Stanford, CA USA
| | | | - Juan Carlos Puyana
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 USA
| | - Andres M. Rubiano
- MEDITECH Foundation, Santiago de Cali, Valle de Cauca, Colombia
- Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia
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St-Louis E, Paradis T, Landry T, Poenaru D. Factors contributing to successful trauma registry implementation in low- and middle-income countries: A systematic review. Injury 2018; 49:2100-2110. [PMID: 30333086 DOI: 10.1016/j.injury.2018.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/05/2018] [Accepted: 10/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trauma registries (TR) provide invaluable data, informing resource allocation and quality improvement. The purpose of this systematic review was to identify factors promoting and inhibiting successful TR implementation in low- and middle-income countries (LMICs). METHODS The protocol was registered a priori (CRD42017058586). With librarian oversight, a peer-reviewed search strategy was developed. Adhering to PRISMA guidelines, two independent reviewers performed first-screen and full-text screening. Studies describing implementation of a TR in LMICs or reviewed the experience of registry users/implementers were included. Extracted data, focusing on publication, institution, registry and data factors, was summarized using descriptive statistics and subjected to thematic qualitative analysis. RESULTS Out of 3842 screened references, 40 articles were included for analysis. Most registries were paper-based, implemented in single publicly-funded institutions within LMICs, benefited from funding, and were run by untrained house-staff with other clinical responsibilities. Constituent variables, injury scoring, outcome assessment, and quality assurance practices were very diverse. Principal obstacles to successful implementation were lack of funding, significant missing data, and insufficient resources. CONCLUSIONS This work may contribute to the planning of future efforts towards TR implementation in LMICs, where better injury data has the potential to alleviate the morbidity and mortality associated with trauma through advocacy and quality-improvement.
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Affiliation(s)
- Etienne St-Louis
- Montreal Children's Hospital, Division of Pediatric General and Thoracic Surgery, Canada; McGill University Health Centre, Centre for Global Surgery, Canada.
| | - Tiffany Paradis
- McGill University Health Centre, Centre for Global Surgery, Canada.
| | - Tara Landry
- McGill University Health Centre, Patient Resource Centre, Canada.
| | - Dan Poenaru
- Montreal Children's Hospital, Division of Pediatric General and Thoracic Surgery, Canada; McGill University Health Centre, Centre for Global Surgery, Canada.
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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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