A survey of trauma database utilisation in England
Introduction
Trauma registries have been in use since as long ago as the ancient Egyptians to document soldiers’ wounds and improve injury management and armour [1]. A more recent and systematic attempt at collecting casualty and medical data was performed by the US Army in the early 19th century, where all communications and reports of the US Army Medical Department were forwarded to the Surgeon General's office, which went on to publish quarterly medical reports, improving the standards of health and living conditions of soldiers. This system became more complex and refined, allowing a wounded soldier's progress to be tracked from injury on the battlefield onwards, becoming vitally important in larger scale conflicts such as the First World War [2].
With the advent of information technology in the 20th century, the computerised trauma database was born and the first modern registry was implemented at Cook County Hospital, Chicago in 1969 using coded keypunch cards and magnetic tape. Within two years, this led to the Illinois State trauma registry, documenting hospital admission details and medical care as well as administrative and outcome data [2].
The data from the Illinois State registry, as well as other state registries created over the next twenty years in the US were soon collated into larger regional and national trauma databases, producing research opportunities, outcome standards and a means by which to benchmark trauma centre performance [3].
By the early 1990s, most of the national trauma databases currently in use in the developed world were in place including the UK based TARN [1]. Inaugurated in 1989 in response to benefits shown by standardising trauma systems in the United States, a group was created in the UK to set up these systems as well as carry out audit and research into injury and systems of care. This produced the UK Major Trauma Outcome Study in 1992 [4] and in the late 1990s the group was renamed the ‘Trauma Audit and Research Network’ [5].
After ten years of collecting data, a report published by TARN showed a ‘variable but valuable’ improvement in trauma care [6]. Publications such as these showing the benefits of trauma systems as well as other research into the value of trauma registries have resulted in changes in legislation such as seat belt or helmet laws [7], as well as the designation of trauma centres; mandating of their upload of data and allocation of resources towards trauma care and research [5], [8], [9], [10].
These findings have also resulted in the increased funding allocated by governments for trauma care. In the UK, annual Department of Health funding for TARN increased fourfold between 1989 and 1996, from £40,000 to £160,000, though with the introduction of participation fees this number steadily fell over the next few years to around £20,000 in 2000 [5]. More recently, data submission to TARN was included in the national tariff, with a Best Practice Tariff of up to £2913 payable to trusts based on a variety of clinical and non-clinical factors, including completion and submission of TARN data within 40 days of discharge [11], [12].
Internationally, amount and sources of funding for regional or national trauma databases has been variable. In the first survey of US state registries, state funding to develop a registry ranged from $0 to $500,000, with annual costs ranging from $0 to $235,000. There was significant geographical variation between states, with only 15 being provided with federal or state grants. Other sources of funding included the hospital, donations or charities and disability grants [7]. A more recent source of funding in the US has been the American College of Surgeons, as well as participation fees, also used in the UK, Japan and Australia [13]. Elsewhere in the world, funding for these registries has been provided from a range of government and public sector sources and is often a combination of these [13].
Despite recent improvements in information technology, updating and maintaining registries is a significant undertaking. During the establishment of the Victorian State Trauma Registry in Australia, the collection, analysis and infrastructure costs were estimated to be over 100 Australian Dollars per patient [8]. Annual maintenance costs can also be significant, as previously described. Data collection and upload to the state or national registry similarly requires significant investment at a local level, especially if this process is manual, as it is in the UK. Use of a more complex data management system able to automate collection or upload may be limited by software incompatibility at a local as well as national level, incurring further financial costs. In this study, we aimed to identify how data was collected at a local level in England; what software and methods were used as well as what resources were allocated to collect and upload trauma data to the TARN.
Section snippets
Methods
A questionnaire was designed to identify what systems and resources were in place at each major trauma centre (MTC) for collecting trauma data and uploading it to TARN, with the questions geared towards assessing the capabilities of the local electronic systems used and whether these would be compatible with an automated link to the TARN registry (Fig. 1).
A list of major trauma centres (MTCs) in England was obtained from the National Health Service website [14] and telephone numbers were
Results
Twenty-six major trauma centres were contacted; twelve combined adult and children's trauma services, eight adult only, four children's only and two ‘collaborative’ MTCs (centres made up of several smaller specialised units such as plastic or neurosurgery but using the same audit and research department). We were unable to contact three for their data.
The majority of hospitals (n = 11) used Microsoft Excel (Microsoft, Redmond, Washington, USA) as a local database for keeping record of the trauma
Discussion
There have been several recent studies reviewing the differences between trauma registries across the world which have demonstrated the variation in methods of data upload and management between countries [13], [16], [17], [18]. There has been little published in the literature, however, assessing the systems in place in individual trauma centres and the potential for developing the infrastructure between the local and national registries within the UK. A recent comparison of European national
Conflict of interest statement
We have no conflicts of interest to declare.
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Correlating injury severity scores and major trauma volume using a state-wide in-patient administrative dataset linked to trauma registry data—A retrospective analysis from New South Wales Australia
2020, InjuryCitation Excerpt :This allows surveillance of injury types, and unwarranted clinical variation to be identified and inform further improvements to patient care [3–6]. However, establishing and maintaining trauma registries is resource intensive, often requiring manual data abstraction and validation by trained registry staff [7–9]. This has often limited the scope of trauma registry data collection to centres where there are trained registry staff, with little to no comparable data from the many acute non-trauma facilities where severely injured patients may present, at least initially.
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2017, Journal of Trauma and Acute Care SurgeryTrauma care inside and outside business hours: Comparison of process quality and outcome indicators in a German level-1 trauma center
2014, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine