K. Bommakanti1, I. Feldhaus1, R. Dicker1, C. Juillard1 1University Of California – San Francisco,Center For Global Surgical Studies,San Francisco, CA, USA
Introduction: Trauma registries are an essential part of injury surveillance and trauma quality improvement programs in high-income countries (HICs), where they have been used to decrease trauma morbidity and mortality. In low- and middle-income countries (LMICs), estimated to have the greatest burden of injury, trauma registries are increasingly being implemented. While some LMICs have managed to successfully implement registries, many others have dealt with challenges in adapting the models used by HICs. We sought to analyze the barriers to trauma registry implementation faced by LMICs in order to inform development of sustainable trauma registry models.
Methods:
A structured review of published literature was performed. Relevant abstracts were identified using the PubMed, Embase, and CINAHL databases. The search terms included were: “implement registry”, “trauma registry”, wounds and injuries”, and “injury registry” combined with "LMIC", “developing countries”, and different world regions. Articles including relevant information on trauma registry implementation were reviewed in full and details were abstracted.
Results:
Thirty articles were identified that addressed the challenges of implementing trauma registries. Overall data quality was cited by seventeen articles as the most significant barrier to success. Difficulty with administrative duties and hospital organization were reported by five studies, while three reported on lack of technology and other infrastructure. Two studies identified insufficient prehospital care as the primary concern and the remaining three cited a lack of human resources, lack of trauma education, and unfavorable health care policies. Solutions to identified barriers were proposed by nine articles and included increasing trauma education, simplifying trauma scoring tools, and transitioning to electronic medical systems. All thirty studies acknowledged that the presence of at least one local trauma registry improved injury surveillance and promoted better outcomes.
Conclusion:
Many LMICs still face unique challenges to implementation that they must overcome to create sustainable trauma databases. Understanding these barriers and their proposed solutions, which include trauma education programs and efforts to standardize injury scoring, may facilitate improved trauma registry implementation in LMICs to further improve trauma care models and have a lasting impact on the development of future programs.
