M. B. Aboutanos1, S. Jayaraman1, L. V. Mata1, E. B. Rodas2, C. A. Ordoñez4, F. Mora6, C. Morales5, M. Quiodettis3, M. Duong1, R. Ivatury1 1Virginia Commonwealth University,Acute Care Surgical Services/ Depart. Surgery,Richmond, VA, USA 2Hospital Vicente Corral Moscoso And Hospital Universitario Del Rio,Surgery,Cuenca, AZUAY, Ecuador 3Hospital Santo Tomas,Trauma,Panama, , Panama 4Hospital Universitario Del Valle And Fundacion Valle De Lili,Trauma,Cali, , Colombia 5San Vicente De Paul,Cirugia,Medellin, , Colombia 6Cinterandes Foundation Mobile Surgical Program,Cuenca, , Ecuador
Introduction:
Injury is a major cause of death and disability in low and middle income countries (LMICs). A major impediment to trauma system development is lack of basic injury data. We aimed to create an injury surveillance system that could be implemented at every level of health facilities in LMICs and which would allow communication across facilities to track injury morbidity and mortality, allow monitoring, evaluation and auditing of trauma care and identify opportunities for intervention.
Methods:
A multi-disciplinary team of program staff, statistician and information technology staff was created and led by a trauma surgeon with previous experience with paper registries in Central America. The team created an electronic trauma registry for low-resource settings that can be used on and offline, in English and Spanish, and covers trauma care from the prehospital trauma setting, initial trauma management, through hospitalization until discharge. The registry consists of two tiers: an essential element tier with 25 variables and a comprehensive tier with 250 variables, uses ICD-10 codes with a built-in search box and calculates injury severity scores (AIS, ISS, RTS and OIS). An integrated quality control system limits incorrect data entry and a report generator allows for pre-specified basic reports and advanced customizable reporting. Specific user roles can be established to control accessibility and facilitate access from any network. A pilot program was implemented with concomitant training in: basic epidemiology and injury surveillance, use of a standardized trauma assessment form, registry access and data entry, analysis and report generation, periodic auditing and quality improvement.
Results:
The registry and a standardized trauma patient assessment form were implemented across nine hospitals in three member countries of the Panamerican Trauma Society: Ecuador, Colombia and Panama. Implementation included sessions for a total of 62 hospital staff including clinicians, hospital administrators and data entry personnel. Since implementation, 28,698 injured patients have been entered into the registry across the nine sites: 6,911 at five hospitals in Ecuador; 20,795 across three hospitals in Colombia; and 992 in Santo Tomas Hospital in Panama. Site-specific analysis is under way.
Conclusion:
LMIC governments practice with significant resource constraints and yet need to develop high quality trauma and emergency systems. This injury registry was created through highly innovative collaboration between clinicians and health informatics experts and can be used capture reliable and accurate data, determine the burden of injury morbidity and mortality and identify opportunities to improve trauma and emergency care. Investment in such information infrastructure has potential to improve resource allocation and facilitate trauma system development in LMICs.