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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
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.
CDC. Report from the 1988 Trauma Registry Workshop, including
recommendations for hospital-based trauma registries. J Trauma
1989;29:827-34.
Cales RH, Kearns ST. Concepts. Trauma Q 1989;5(3):1-8.
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.
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.
Division of Emergency Medical Services, Department of Health
Services. County of San Diego annual trauma system report.
California: County of San Diego, 1989.
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.
Chapter 290, Virginia Acts of Assembly, 1989.
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.
Disclaimer
All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov. Page converted: 08/05/98
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