Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 6 , ISSUE 3 ( September-December, 2017 ) > List of Articles

RESEARCH ARTICLE

Identifying Pediatric Trauma Data Gaps at a Large Urban Trauma Referral Center in Santiago, Chile

Etienne St-Louis, Daniel Roizblatt, Dan L Deckelbaum, Robert Baird, César V Millán, Alicia Ebensperger

Citation Information : St-Louis E, Roizblatt D, Deckelbaum DL, Baird R, Millán CV, Ebensperger A. Identifying Pediatric Trauma Data Gaps at a Large Urban Trauma Referral Center in Santiago, Chile. Panam J Trauma Crit Care Emerg Surg 2017; 6 (3):169-176.

DOI: 10.5005/jp-journals-10030-1188

License: CC BY 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

Trauma registries contribute to improving trauma care, but their impact is highly dependent on the quality of the data. A simplified point of care pediatric trauma registry (PTR) was developed at the Centre for Global Surgery from the McGill University Health Centre (MUHC) for implementation in Low-middle income countries (LMICs). Pilot deployment was launched at a large urban trauma center in May 2016 in Santiago, Chile. Prior to deployment, we sought to identify missing data in existing trauma records in order to optimize PTR practicality and user benefit.

Materials and methods

The project was approved by the local Institutional Review Board. Retrospective chart review was conducted on trauma patients below the age of 15 who were evaluated at the emergency room (ER) of Hospital Dr. Sotero del Rio (HSR) between January 1st and June 30th 2015. Data missingness was evaluated for each component of the PTR (demographics, mechanism, injury and outcomes). Potential independent predictors of data missingness were evaluated using multiple linear regression.

Results

A total of 351 patients were included. Demographic data missingness ranged from 0% (age) to 95% (mode of arrival). Mechanism data missingness ranged from 6% (cause of injury) to 42% (site of injury). Injury physiology data missingness ranged from 37% (oxygen saturation) to 99% (respiratory rate). Interestingly, mean injury anatomy data missingness was significantly inferior to physiology data (0.6% vs. 78.6%, p < 0.05). Outcome data missingness reached 54% at 2 weeks.

Conclusion

In resource-limited settings, high quality data is essential to guide responsible resource allocation. We believe implementation of a simplified trauma registry has the potential to reduce data gaps for pediatric trauma patients by streamlining trauma data collection at point of care. This should include streamlined data collection with a short per-patient completion time, and should forego attempts to collect data at 2 weeks, which has proven unsuccessful.

How to cite this article

St-Louis E, Roizblatt D, Deckelbaum DL, Baird R, Millán CV, Ebensperger A, Razek T. Identifying Pediatric Trauma Data Gaps at a Large Urban Trauma Referral Center in Santiago, Chile. Panam J Trauma Crit Care Emerg Surg 2017;6(3):169-176.

Antecedentes

Los registros de trauma contribuyen a mejorar la atención traumatológica, pero su impacto depende en gran medida de la calidad de los datos. En el Centro de Cirugía Global del Centro de Salud de la Universidad de McGill se desarrolló un registro simplificado de trauma pediátrico en el punto de atención (PTR) para su implementación en países de ingresos medios bajos (LMIC, por sus siglas en inglés). El despliegue piloto fue lanzado en un gran centro de traumatología urbana en mayo de 2016 en Santiago, Chile. Antes del despliegue, se buscó identificar los datos faltantes en los registros de trauma existentes a fin de optimizar la practicidad PTR y el beneficio del usuario.

Métodos

El proyecto fue aprobado por la Junta de Revisión Institucional local. Se realizó una revisión retrospectiva de los pronósticos de los pacientes con traumatismos menores de 15 años que fueron evaluados en la sala de urgencias del Hospital Dr. Sotero del Río entre el 1 de enero y el 30 de junio de 2015. Se evaluó la falta de datos para cada componente del PTR , Mecanismo, lesión y resultados). Los potenciales predictores independientes de la falta de datos se evaluaron mediante regresión lineal múltiple.

Resultados

Se incluyeron 351 pacientes. La falta de datos demográficos osciló entre 0% (edad) y 95% (modo de llegada). La falta de datos del mecanismo osciló entre el 6% (causa de la lesión) y el 42% (sitio de la lesión). La falta de datos de la fisiología de lesiones osciló entre el 37% (saturación de oxígeno) y el 99% (frecuencia respiratoria). Curiosamente, los datos de anatomía de lesión media faltantes fueron significativamente inferiores a los datos fisiológicos (0,6% vs 78,6%, p <0,05). La falta de datos de resultados alcanzó el 54% a las 2 semanas.

Conclusiones

En entornos de recursos limitados, los datos de alta calidad son esenciales para orientar la asignación responsable de recursos. Creemos que la implementación de un registro de trauma simplificado tiene el potencial de reducir las lagunas de datos para los pacientes pediátricos traumatizados mediante la racionalización de la recogida de datos de trauma en el punto de atención. Esto debería incluir una recolección de datos simplificada con un tiempo de finalización corto por paciente, y debería renunciar a los intentos de recopilar datos a las 2 semanas, lo que ha resultado infructuoso.


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