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Benchmarking of Trauma Care Worldwide: The Potential Value of an International Trauma Data Bank (ITDB)

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Abstract

Background

National trauma registries have helped improve patient outcomes across the world. Recently, the idea of an International Trauma Data Bank (ITDB) has been suggested to establish global comparative assessments of trauma outcomes. The objective of this study was to determine whether global trauma data could be combined to perform international outcomes benchmarking.

Methods

We used observed/expected (O/E) mortality ratios to compare two trauma centers [European high-income country (HIC) and Asian lower-middle income country (LMIC)] with centers in the North American National Trauma Data Bank (NTDB). Patients (≥16 years) with blunt/penetrating injuries were included. Multivariable logistic regression, adjusting for known predictors of trauma mortality, was performed. Estimates were used to predict the expected deaths at each center and to calculate O/E mortality ratios for benchmarking.

Results

A total of 375,433 patients from 301 centers were included from the NTDB (2002–2010). The LMIC trauma center had 806 patients (2002–2010), whereas the HIC reported 1,003 patients (2002–2004). The most important known predictors of trauma mortality were adequately recorded in all datasets. Mortality benchmarking revealed that the HIC center performed similarly to the NTDB centers [O/E = 1.11 (95 % confidence interval (CI) 0.92–1.35)], whereas the LMIC center showed significantly worse survival [O/E = 1.52 (1.23–1.88)]. Subset analyses of patients with blunt or penetrating injury showed similar results.

Conclusions

Using only a few key covariates, aggregated global trauma data can be used to adequately perform international trauma center benchmarking. The creation of the ITDB is feasible and recommended as it may be a pivotal step towards improving global trauma outcomes.

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Acknowledgment

The authors thank Mary Lodenkemper for her editorial assistance and coordination. National Institutes of Health/NIGMS K23GM093112-01 and American College of Surgeons C. James Carrico Fellowship for the study of Trauma and Critical Care (Dr. Haider); Agency for Healthcare Research & Quality K081K08HS017952-01 (Dr. Haut).

Conflict of interest

None of the authors report any potential or real conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Center for Surgical Trials and Outcomes Research, The Johns Hopkins School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Suite 6107, Baltimore, MD, 21287-4688, USA

    Adil H. Haider, Zain G. Hashmi, Sonia Gupta, David T. Efron, Kent A. Stevens, Eric B. Schneider & Elliott R. Haut

  2. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Adil H. Haider

  3. Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA

    Adil H. Haider, David T. Efron, Kent A. Stevens & Elliott R. Haut

  4. Department of Surgery, Howard University College of Medicine, Washington, DC, USA

    Syed Nabeel Zafar

  5. Department of Anesthesiology and Critical Care Medicine, Lyon Sud Hospital, Hospices Civils de Lyon (HCL), Pierre Benite, France

    Jean-Stephane David

  6. Charles Merieux Lyon-Sud School of Medicine, University Lyon 1, Oullins, France

    Jean-Stephane David

  7. Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

    Hasnain Zafar

  8. Department of Surgery, Trauma and Emergency Surgery Unit, Lyon Sud Hospital (HCL), Pierre Benite, France

    Eric Voiglio

  9. Lyon-Est School of Medicine, University Lyon 1, Lyon, France

    Eric Voiglio

  10. Department of Surgery, UC San Diego, School of Medicine, San Diego, CA, USA

    Raul Coimbra

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  1. Adil H. Haider
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  2. Zain G. Hashmi
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  3. Sonia Gupta
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  4. Syed Nabeel Zafar
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  5. Jean-Stephane David
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  6. David T. Efron
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  7. Kent A. Stevens
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  8. Hasnain Zafar
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  9. Eric B. Schneider
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  11. Raul Coimbra
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  12. Elliott R. Haut
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Corresponding author

Correspondence to Adil H. Haider.

Additional information

This work was declared as the best oral presentation at the International Association for Trauma Surgery and Intensive Care/the American Association for the Surgery of Trauma (IATSIC/AAST) Scientific Paper Session at the International Surgical Week (ISW) 2013, Helsinki, Finland.

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Haider, A.H., Hashmi, Z.G., Gupta, S. et al. Benchmarking of Trauma Care Worldwide: The Potential Value of an International Trauma Data Bank (ITDB). World J Surg 38, 1882–1891 (2014). https://doi.org/10.1007/s00268-014-2629-5

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