World Journal of Surgery

, Volume 38, Issue 8, pp 1882–1891

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

  • Adil H. Haider
  • Zain G. Hashmi
  • Sonia Gupta
  • Syed Nabeel Zafar
  • Jean-Stephane David
  • David T. Efron
  • Kent A. Stevens
  • Hasnain Zafar
  • Eric B. Schneider
  • Eric Voiglio
  • Raul Coimbra
  • Elliott R. Haut



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.


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.


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.


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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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Adil H. Haider
    • 1
    • 2
    • 3
  • Zain G. Hashmi
    • 1
  • Sonia Gupta
    • 1
  • Syed Nabeel Zafar
    • 4
  • Jean-Stephane David
    • 5
    • 6
  • David T. Efron
    • 1
    • 3
  • Kent A. Stevens
    • 1
    • 3
  • Hasnain Zafar
    • 7
  • Eric B. Schneider
    • 1
  • Eric Voiglio
    • 8
    • 9
  • Raul Coimbra
    • 10
  • Elliott R. Haut
    • 1
    • 3
  1. 1.Department of Surgery, Center for Surgical Trials and Outcomes ResearchThe Johns Hopkins School of MedicineBaltimoreUSA
  2. 2.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of Anesthesiology & Critical Care MedicineThe Johns Hopkins School of MedicineBaltimoreUSA
  4. 4.Department of SurgeryHoward University College of MedicineWashingtonUSA
  5. 5.Department of Anesthesiology and Critical Care MedicineLyon Sud Hospital, Hospices Civils de Lyon (HCL)Pierre BeniteFrance
  6. 6.Charles Merieux Lyon-Sud School of MedicineUniversity Lyon 1OullinsFrance
  7. 7.Department of SurgeryAga Khan University HospitalKarachiPakistan
  8. 8.Department of Surgery, Trauma and Emergency Surgery UnitLyon Sud Hospital (HCL)Pierre BeniteFrance
  9. 9.Lyon-Est School of MedicineUniversity Lyon 1LyonFrance
  10. 10.Department of SurgeryUC San Diego, School of MedicineSan DiegoUSA

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