Current Trends National Survey of Trauma Registries -- United States, 1987

In 1988, a National Academy of Sciences panel recommended that CDC promote the development of a national data set for injury epidemiology, including standardized trauma registries in each state (1). The panel emphasized that existing deficiencies in injury surveillance have hampered the implementation of effective public health measures for injury control. In January 1988, a workshop* was held at CDC to develop standard case criteria and a uniform, minimum data set for trauma registries (TRs) (2). TRs are information systems maintained primarily to monitor the prehospital and hospital care of severely injured persons (3). Hospital TRs are located at individual institutions; regional and state TRs are central registries that aggregate data from two or more hospital TRs.

In 1987, two mailout surveys were conducted by the emergency services department of the San Francisco General Hospital, under the auspices of the National Association of State Emergency Medical Services Directors. In the first survey, emergency medical service directors responded from all 50 states and the District of Columbia. Ten states** had legal requirements for the establishment of central TRs; six of these states required participation by all acute-care hospitals, and four required participation by only trauma center hospitals.

In the second survey, of 248 trauma coordinators (TCs) responsible for maintaining TRs at the hospital, regional, and state levels, 147 (59%) responded. TRs were operational in a minimum of 105 hospitals in 35 states. TRs differed in case criteria, data content, coding conventions, and the manner in which data were used.

Emergency medical service directors, TCs, and others responsible for developing TRs must choose from a variety of existing systems or develop their own. Consensus development of standards for TRs was endorsed by 80% of the state emergency medical service directors and 66% of TCs who participated in the surveys. Reported by: RH Cales, MD, San Francisco General Hospital. ST Kearns, MSN, Palm Beach County Emergency Medical Svcs; LS Jordan, Office of Emergency Medical Svcs, Florida Dept of Health and Rehabilitative Svcs. Biometrics Br, Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Hospital and central TRs can be used to evaluate the quality of trauma care. For example, in San Diego County, California, the Division of Emergency Medical Services monitors hospital trauma care using data from three sources: TRs maintained at six trauma center hospitals, traumatic injury reports (a subset of the TR data) submitted by 24 nontrauma center hospitals, and the county coroner's records of deaths of patients who received hospital care for trauma (4). The San Diego County Medical Audit Committee (MAC), composed of representatives from the Division of Emergency Medical Services, trauma center and nontrauma center hospitals, and the coroner's office, meets monthly and reviews morbidity and mortality among patients hospitalized for major trauma. The MAC classifies the deaths as nonpreventable, potentially salvageable, or preventable if treatment had been altered. These reviews have found that preventable deaths declined among hospital trauma patients following the implementation of a regional trauma system in San Diego County in 1984 (5,6).

Data from TRs can be used to support primary prevention initiatives. For example, in Virginia, a legislative subcommittee used data from the Virginia Statewide Trauma Registry and other data sources to recommend legislation regulating the use of all-terrain vehicles (ATVs) (7). From January 1987 through August 1988, at least 120 persons sustained ATV-related injuries in Virginia, including 27 persons less than 12 years of age and 19 persons aged 12-16 years. Legislation enacted in 1989 by the General Assembly of Virginia prohibits use of ATVs by persons less than 12 years of age, restricts use by those aged 12-16 years, requires operators to wear helmets, and forbids passengers (8).

TRs are also a potential source of data for ongoing surveillance of morbidity and mortality resulting from specific types of injuries, such as blunt trauma, penetrating trauma, and burns (9).

The TR workshop provided the first opportunity for a multidisciplinary group of researchers, medical practitioners, public health officials, and health-care administrators to participate in the formulation of standards for TRs. Based on the results of the workshop, recommendations for TRs (2) and a comprehensive guide to the recommended data definitions and coding formats for TRs have been developed and are available from CDC.***

References

1. Committee to Review the Status and Progress of the Injury Control Program at the Centers for Disease Control. Injury control: a review of status and progress of the injury control program at the Centers for Disease Control. Washington, DC: National Academy Press, 1988.

2. CDC. Report from the 1988 Trauma Registry Workshop, including recommendations for hospital-based trauma registries. J Trauma 1989;29:827-34.

3. Cales RH, Kearns ST. Concepts. Trauma Q 1989;5(3):1-8.

4. Shackford SR, Hollingsworth-Fridlund P, McArdle M, Eastman AB. Assuring quality in a trauma system--The Medical Audit Committee: composition, cost, and results. J Trauma 1987;27:866-75.

5. Shackford SR, Hollingsworth-Fridlund P, Cooper GF, Eastman AB. The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report. J Trauma 1986;26:812-20.

6. Division of Emergency Medical Services, Department of Health Services. County of San Diego annual trauma system report. California: County of San Diego, 1989.

7. Report of the joint subcommittee studying all-terrain vehicles to the governor and the general assembly of Virginia (Senate document no. 13). Commonwealth of Virginia, 1989.

8. Chapter 290, Virginia Acts of Assembly, 1989.

9. Pollock DA, McClain PW. Trauma registries: current status and future prospects. JAMA 1989;262:2280-3.foots *The cosponsors of the Trauma Registry Workshop were the American College of Emergency Physicians, the American College of Surgeons, the American Medical Association Commission on Emergency Medical Services, the National Highway Traffic Safety Administration, and CDC. **Georgia, Maryland, Missouri, North Carolina, Nevada, New Mexico, Oregon, Pennsylvania, Virginia, and West Virginia. In addition, beginning in 1988, Florida has also required all acute-care hospitals to participate in a statewide TR. ***Available from: Biometrics Branch, Division of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC, Mailstop F36, Atlanta, GA 30333.

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