Mehmood, Amber

Razzak, Junaid Abdul

English

eCommons@AKU

eCommons@AKUDepartment of Emergency Medicine Medical College, PakistanDecember 2009Trauma registry needs and challenges in developingcountries.Amber MehmoodAga Khan University, amber.mehmood@aku.eduJunaid Abdul RazzakAga Khan University, junaid.razzak@aku.eduFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_emerg_medPart of the Emergency Medicine CommonsRecommended CitationMehmood, A., Razzak, J. A. (2009). Trauma registry needs and challenges in developing countries.. Journal of Pakistan MedicalAssociation, 59(12), 807-808.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_emerg_med/170Vol. 59, No. 12, December 2009 807Injury is a leading cause of morbidity and mortalityin both the developed and the developing world.1,2 InPakistan, injuries are the second leading cause of disability,11th leading cause of premature death, and the fifth leadingcause of healthy years of life lost per 1000 people.3,4 Apartfrom motor vehicle injuries and homicides, reliableinformation on the event, type and nature of injuries andtheir outcomes is not available. Reasons for lack ofinformation include absence of a comprehensive nationaltrauma data base.2,5,6Data for injuries in many countries includingPakistan are obtained from Police. These data underestimateinjury burden and provide no information on the types ofinjury, short and long term outcomes and quality of traumacare.2,5,7, Surveys, another source of data whilecomprehensive in terms of injury burden estimates, areoften costly and lack the "real-time" impact.2,6 Facility orambulance based surveillance on the other hand lack thedepth of information required to effect quality of careimprovements.8One of the methods used to collect information onthe quality of trauma care is through the use of TraumaRegistry (TR).7,9-11 TRs are an integral part of traumasystems data collection and outcome assessmentmethodology in most developed trauma systems.12,13Evidence supports an improved trauma care through the useof functionally active and well organized traumaregistries.12-16In simple terms, trauma registry is a system of datacollection that serves as a source of information for theevaluation of trauma care for a specific set of injuredpatients meeting well defined inclusion criteria.9,11,12Primarily it consists of hospital based trauma data, and oftencontains information obtained from the Emergency MedicalServices (EMS) and rehabilitation. Besides demographicinformation, A TR typically collects information on thetype, cause and severity of injury; details of the careprovided at various levels of care system (EMS, EmergencyDepartment, Operating Room, ICU, Ward, RehabilitationUnits etc); outcome in terms of death and disability.11,16 TRalso estimate the probability of death of a given patientcompared to a patients with similar severity of injuries inthe larger database from multiple centers.17 Thisinformation gives institutions an estimate of theirperformance compared to peer institutions. Data thusobtained is used for accreditation, verification anddesignation of trauma centers as well as the credentialing ofhealth care providers.11There are many challenges in implementing TR indeveloping countries though there is an interest in manydeveloping countries such as Uganda, Ethiopia, Egypt andHaiti.7,18 First, obtaining the registry software can be adaunting task. Developing one locally is possible though itcan be time consuming and requires collaboration betweenhealth care professionals and software developers. Clarity isneeded on the choice of essential variables, type of datarepository capable of storage of large amount ofinformation, coding system backup, and data processingand analysis tools. The success of the software also dependsupon the operating system requirements, its functionality asstandalone vs. web-based database, hardware requirementsuch as disk space, server and backup systems.11Implementation is often a bigger challenge requiringplanning, continuous commitment, training, monitoring andevaluation. Obtaining buy-in from all stakeholders is thefirst challenge in successful implementation. It requireshigh level of commitment to the quality for the institutionsand individual providers to open themselves up to thepossible undesirable quality indicators. Secondly, thetraining human resources in medical terminology, dataextraction, ICD coding, injury severity scaling and survivalprobability is essential. The third challenge is designing adata collection strategy to access patients' confidential datawhile conforming to the institutional guidelines andpolicies. Fourthly, data validation for timeliness,completeness and accuracy is of paramount importance toensure their utility in meaningful interventions. Cost whichis often a source of concern for developing countryinstitutions can be reduced by limiting collection ofredundant information.9In summary, TR could play a vital role in filling thegap of injury information for health related outcomes inPakistan. It will also help enhance trauma care quality byidentifying trauma system gaps and practice improvementopportunities. The data generated through the registry couldalso be used for public health surveillance, injury research,economic analysis, and public policy interventions. Buy-infrom health care leadership, a cost-effective and practicalEditorialTrauma registry — needs and challenges in developing countriesAmber Mehmood, Junaid Abdul RazzakDepartment of Emergency Medicine, Aga Khan University, Karachi.808 J Pak Med Assocsoftware solution and systems of obtaining data and usinginformation for patient care improvements are some of theessential requirements if trauma registry is to beimplemented in Pakistan.References1. Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J PublicHealth 2000; 90: 523-6.2. Fatmi Z, Hadden WC, Razzak JA, Qureshi HI, Hyder AA, Pappas G.Incidence, patterns and severity of reported unintentional injuries in Pakistanfor persons five years and older: results of the National Health Survey ofPakistan 1990-94. BMC Public Health 2007; 7:152. 3. Ali M, Miyoshi C, Ushijima H. Emergency medical services in Islamabad,Pakistan: a public-private partnership. Public Health 2006; 120: 50-7.4. Hyder AA, Morrow RH. Applying burden of disease methods in developingcountries: a case study from Pakistan. Am J Public Health 2000; 90: 1235-40. 5. Ghaffar A, Hyder AA, Mastoor MI, Shaikh I.Injuries in Pakistan: directionsfor future health policy. Health Policy Plan 1999; 14: 11-7. 6. Ghaffar A, Hyder AA, Masud TI. The burden of road traffic injuries indeveloping countries: the 1st national injury survey of Pakistan. Public Health2004; 118: 211-7. 7. Kobusingye OC, Lett RR. Hospital-based trauma registries in Uganda. JTrauma 2000; 48: 498-502. 8. Razzak JA, Laflamme L. Limitations of secondary data sets for road trafficinjury epidemiology: a study from Karachi, Pakistan. Prehosp Emerg Care2005; 9: 355-60.9. Rutledge R. The goals, development, and use of trauma registries andtrauma data sources in decision making in injury. Surg Clin North Am1995; 75: 305-26.10. Pollock DM, Trauma registries and Public health surveillance; NCHS-International collaborative effort on Injury Statistics. (Online) 2009 (Cited 2009July 7). Available from URL: http://www.cdc.gov/nchs/data/ice/ice95v1/c11.11. Nwomeh BC, Lowell W, Kable R, Haley K, Ameh EA. History anddevelopment of trauma registry: lessons from developed to developingcountries. World J Emerg Surg 2006; 1:32. 12. Moore L, Clark DE. The value of trauma registries. Injury 2008; 39: 686-95.13. E.J. MacKenzie, F.P. Rivara and G.J. Jurkovich et al., A national evaluation ofthe effect of trauma-center care on mortality. N Engl J Med 2006; 354: 366-78.14. Sampalis JS, Lavoie A, Boukas S, Tamim H, Nikolis A, Fréchette P, et al.Trauma center designation: initial impact on trauma-related mortality. JTrauma 1995; 39: 232-7.15. Shackford SR, Hollingworth-Fridlund P, Cooper GF, Eastman AB. The effectof regionalization upon the quality of trauma care as assessed by concurrentaudit before and after institution of a trauma system: a preliminary report. JTrauma 1986; 26: 812-20.16. Lucas CE, Buechter KJ, Coscia RL, Hurst JM, Lane V, Meredith JW, et al. Theeffect of trauma program registry on reported mortality rates. J Trauma 2001;51: 1122-7.17. Zafar H, Rehmani R, Raja AJ, Ali A, Ahmed M. Registry based traumaoutcome: perspective of a developing country. Emerg Med J 2002; 19: 391-4.18. Schultz CR, Ford HR, Cassidy LD, Shultz BL, Blanc C, King-Schultz LW, etal. Development of a hospital-based trauma registry in Haiti: an approach forimproving injury surveillance in developing and resource-poor settings. JTrauma 2007; 63: 1143-54. 

Trauma registry needs and challenges in developing countries.

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Trauma registry needs and challenges in developing countries.

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