Trauma registry data as a tool for comparison of practice patterns and outcomes between low- and middle-income and high-income healthcare settings

Michael D. Traynor, Matthew C. Hernandez, Omair Shariq, Wanda Bekker, John L. Bruce, Elizabeth B Habermann, Amy E. Glasgow, Grant L. Laing, Victor Y. Kong, Johan J.P. Buitendag, Denise B. Klinkner, Christopher Moir, Damian L. Clarke, Martin D. Zielinski, Stephanie F. Polites

Research output: Contribution to journalArticle

Abstract

Purpose: There is a lack of data-driven, risk-adjusted mortality estimates for injured children outside of high-income countries (HIC). To inform injury prevention and quality improvement efforts, an upper middle-income country (UMIC) pediatric trauma registry was compared to that of a HIC. Methods: Clinical data, injury details, and mortality of injured children (< 18 years) hospitalized in two centers (USA and South African (SA)) from 2013 to 2017 were abstracted. Univariate and multivariable analyses evaluated risk of mortality and were expressed as odds ratios (OR) with 95% confidence intervals (CI). Results: Of 2089 patients, SA patients had prolonged transfer times (21.1 vs 3.4 h) and were more likely referred (78.2% vs 53.9%; both p < 0.001). Penetrating injuries were more frequent in SA (23.2% vs 7.4%, p < 0.001); injury severity (9 vs 4) and shock index (0.90 vs 0.80) were greater (both p < 0.001). SA utilized cross-sectional imaging more frequently (66.4% vs 37.3%, p < 0.001). In-hospital mortality was similar (1.9% SA, 1.3% USA, p = 0.31). Upon multivariable analysis, ISS > 25 [210.50 (66.0-671.0)] and penetrating injury [5.5 (1.3–23.3)] were associated with mortality, while institution [1.7 (0.7–4.2)] was not. Conclusions: Despite transfer time, the centers demonstrated comparable survival rates. Comparison of registry data can alert clinicians to problematic practice patterns, assisting initiatives to improve trauma systems.

Original languageEnglish (US)
Pages (from-to)699-708
Number of pages10
JournalPediatric Surgery International
Volume35
Issue number6
DOIs
StatePublished - Jun 7 2019

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Registries
Delivery of Health Care
Wounds and Injuries
Child Mortality
Mortality
Quality Improvement
Survival Rate
Pediatrics

Keywords

  • Africa
  • Children
  • High-income country (HIC)
  • Injury
  • Low- and middle-income countries
  • Pediatric trauma
  • South Africa
  • Trauma registry

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Trauma registry data as a tool for comparison of practice patterns and outcomes between low- and middle-income and high-income healthcare settings. / Traynor, Michael D.; Hernandez, Matthew C.; Shariq, Omair; Bekker, Wanda; Bruce, John L.; Habermann, Elizabeth B; Glasgow, Amy E.; Laing, Grant L.; Kong, Victor Y.; Buitendag, Johan J.P.; Klinkner, Denise B.; Moir, Christopher; Clarke, Damian L.; Zielinski, Martin D.; Polites, Stephanie F.

In: Pediatric Surgery International, Vol. 35, No. 6, 07.06.2019, p. 699-708.

Research output: Contribution to journalArticle

Traynor, MD, Hernandez, MC, Shariq, O, Bekker, W, Bruce, JL, Habermann, EB, Glasgow, AE, Laing, GL, Kong, VY, Buitendag, JJP, Klinkner, DB, Moir, C, Clarke, DL, Zielinski, MD & Polites, SF 2019, 'Trauma registry data as a tool for comparison of practice patterns and outcomes between low- and middle-income and high-income healthcare settings', Pediatric Surgery International, vol. 35, no. 6, pp. 699-708. https://doi.org/10.1007/s00383-019-04453-w
Traynor, Michael D. ; Hernandez, Matthew C. ; Shariq, Omair ; Bekker, Wanda ; Bruce, John L. ; Habermann, Elizabeth B ; Glasgow, Amy E. ; Laing, Grant L. ; Kong, Victor Y. ; Buitendag, Johan J.P. ; Klinkner, Denise B. ; Moir, Christopher ; Clarke, Damian L. ; Zielinski, Martin D. ; Polites, Stephanie F. / Trauma registry data as a tool for comparison of practice patterns and outcomes between low- and middle-income and high-income healthcare settings. In: Pediatric Surgery International. 2019 ; Vol. 35, No. 6. pp. 699-708.
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AU - Traynor, Michael D.

AU - Hernandez, Matthew C.

AU - Shariq, Omair

AU - Bekker, Wanda

AU - Bruce, John L.

AU - Habermann, Elizabeth B

AU - Glasgow, Amy E.

AU - Laing, Grant L.

AU - Kong, Victor Y.

AU - Buitendag, Johan J.P.

AU - Klinkner, Denise B.

AU - Moir, Christopher

AU - Clarke, Damian L.

AU - Zielinski, Martin D.

AU - Polites, Stephanie F.

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N2 - Purpose: There is a lack of data-driven, risk-adjusted mortality estimates for injured children outside of high-income countries (HIC). To inform injury prevention and quality improvement efforts, an upper middle-income country (UMIC) pediatric trauma registry was compared to that of a HIC. Methods: Clinical data, injury details, and mortality of injured children (< 18 years) hospitalized in two centers (USA and South African (SA)) from 2013 to 2017 were abstracted. Univariate and multivariable analyses evaluated risk of mortality and were expressed as odds ratios (OR) with 95% confidence intervals (CI). Results: Of 2089 patients, SA patients had prolonged transfer times (21.1 vs 3.4 h) and were more likely referred (78.2% vs 53.9%; both p < 0.001). Penetrating injuries were more frequent in SA (23.2% vs 7.4%, p < 0.001); injury severity (9 vs 4) and shock index (0.90 vs 0.80) were greater (both p < 0.001). SA utilized cross-sectional imaging more frequently (66.4% vs 37.3%, p < 0.001). In-hospital mortality was similar (1.9% SA, 1.3% USA, p = 0.31). Upon multivariable analysis, ISS > 25 [210.50 (66.0-671.0)] and penetrating injury [5.5 (1.3–23.3)] were associated with mortality, while institution [1.7 (0.7–4.2)] was not. Conclusions: Despite transfer time, the centers demonstrated comparable survival rates. Comparison of registry data can alert clinicians to problematic practice patterns, assisting initiatives to improve trauma systems.

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