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World Journal of Surgery

, Volume 37, Issue 7, pp 1506–1512 | Cite as

The Implementation of a Pilot Femur Fracture Registry at Komfo Anokye Teaching Hospital: An Analysis of Data Quality and Barriers to Collaborative Capacity-Building

  • Daniel B. SonshineEmail author
  • Jesse Shantz
  • Raphael Kumah-Ametepey
  • R. Richard Coughlin
  • Richard A. Gosselin
Article

Abstract

Background

Trauma registries are essential for injury surveillance and recognition of the burden of musculoskeletal injury in low- and middle-income countries (LMICs). The purpose of this study was to pilot a femur fracture registry at Komfo Anokye Teaching Hospital (KATH) to assess data quality and determine the barriers to research partnering in LMICs.

Methods

All patients admitted to KATH with a fracture of the femur, or Arbeitsgemeinschaft für Osteosynthesefragen (AO) class 31, 32, 33, were entered into a locally designed, electronic femur fracture database. Patients’ characteristics and data quality were assessed by using descriptive statistics. Orthopedic trauma research barriers and opportunities were identified from key informants at the research site and supporting site.

Results

Ninety-six femur fracture patients were enrolled into the registry over a 5-week period. The majority of patients resided in the Ashanti region surrounding the hospital (78 %). Most participants were involved in a road traffic crash (58 %) and physiologically stable with a Cape Triage Score of yellow upon admission (84 %). AO class 32 femur fractures represented the majority of femur fractures (78 %). Median times from injury to admission, admission to surgery, and surgery to discharge were 0, 5, and 10 days, respectively. Data quality analysis showed that data collected at admission had higher rates of completion in the database relative to data collected at various follow-up time points.

Conclusions

Data and data quality analyses highlighted characteristics of femur fracture patients presenting to KATH as well as the technological, administrative support, and hospital systems-based challenges of longitudinal data collection in LMICs.

Keywords

Femur Fracture Orthopedic Trauma Musculoskeletal Injury Trauma Registry Injury Surveillance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors thank the IGOT team, including Felicia Agbenorwu and Eric Anyimadu, for their help coordinating the study and collecting data at KATH as well as Peter Trafton, MD, for his study design guidance.

References

  1. 1.
    Clough JF, Zirkle LG, Schmitt RJ (2010) The role of SIGN in the development of a global orthopaedic trauma database. Clin Orthop Relat Res 468:2592–2597PubMedCrossRefGoogle Scholar
  2. 2.
    Beveridge M, Howard A (2004) The burden of orthopaedic disease in developing countries. J Bone Joint Surg Am 86-A:1819–1822PubMedGoogle Scholar
  3. 3.
    Zirkle LG Jr (2008) Injuries in developing countries–how can we help? The role of orthopaedic surgeons. Clin Orthop Relat Res 466:2443–2450PubMedCrossRefGoogle Scholar
  4. 4.
    Sekimpi P, Okike K, Zirkle L, Jawa A (2011) Femoral fracture fixation in developing countries: an evaluation of the Surgical Implant Generation Network (SIGN) intramedullary nail. J Bone Joint Surg Am 93:1811–1818PubMedCrossRefGoogle Scholar
  5. 5.
    Mock C, Cherian MN (2008) The global burden of musculoskeletal injuries: challenges and solutions. Clin Orthop Relat Res 466:2306–2316PubMedCrossRefGoogle Scholar
  6. 6.
    Gosselin RA (2009) The increasing burden of injuries in developing countries: direct and indirect consequences. Tech Orthop 24:230–232 210.1097/BTO.1090b1013e3181bfd1056cCrossRefGoogle Scholar
  7. 7.
    Shearer D, Zirkle LGJ (2009) Future Directions for Assisting Orthopedic Surgery in the Developing World. Tech Orthop 24:312–315 310.1097/BTO.1090b1013e3181c1093e1098e1096CrossRefGoogle Scholar
  8. 8.
    Wild M, Candrian A, Wenda K (2009) Possibilities and limits of Internet-based registers. Inform Health Soc Care 34:81–90PubMedCrossRefGoogle Scholar
  9. 9.
    Nwomeh BC, Lowell W, Kable R, Haley K, Ameh EA (2006) History and development of trauma registry: lessons from developed to developing countries. World J Emerg Surg 1:32PubMedCrossRefGoogle Scholar
  10. 10.
    Mehmood A, Razzak JA (2009) Trauma registry–needs and challenges in developing countries. J Pak Med Assoc 59:807–808PubMedGoogle Scholar
  11. 11.
    Shaban S, Ashour M, Bashir M, El-Ashaal Y, Branicki F, Abu-Zidan FM (2009) The long-term effects of early analysis of a trauma registry. World J Emerg Surg 4:42PubMedCrossRefGoogle Scholar
  12. 12.
    Hansen E, Bozic KJ (2009) The impact of disruptive innovations in orthopaedics. Clin Orthop Relat Res 467:2512–2520PubMedCrossRefGoogle Scholar
  13. 13.
    Gosselin RA, Heitto M, Zirkle L (2009) Cost-effectiveness of replacing skeletal traction by interlocked intramedullary nailing for femoral shaft fractures in a provincial trauma hospital in Cambodia. Int Orthop 33:1445–1448PubMedCrossRefGoogle Scholar
  14. 14.
    Gosselin R, Lavaly D (2007) Perkins traction for adult femoral shaft fractures: a report on 53 patients in Sierra Leone. Int Orthop 31:697–702PubMedCrossRefGoogle Scholar
  15. 15.
    Gottschalk SB, Wood D, DeVries S, Wallis LA, Bruijns S (2006) The cape triage score: a new triage system South Africa. Proposal from the cape triage group. Emerg Med J 23:149–153PubMedCrossRefGoogle Scholar
  16. 16.
    Wallis PA, Gottschalk SB, Wood D, Bruijns S, de Vries S, Balfour C (2006) The Cape Triage Score—a triage system for South Africa. S Afr Med J 96:53–56PubMedGoogle Scholar
  17. 17.
    Damsere-Derry J, Ebel BE, Mock CN, Afukaar F, Donkor P (2010) Pedestrians’ injury patterns in Ghana. Accid Anal Prev 42:1080–1088PubMedCrossRefGoogle Scholar
  18. 18.
    Spiegel DA, Gosselin RA, Coughlin RR, Joshipura M, Browner BD, Dormans JP (2008) The burden of musculoskeletal injury in low and middle-income countries: challenges and opportunities. J Bone Joint Surg Am 90:915–923PubMedCrossRefGoogle Scholar
  19. 19.
    Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3:e442PubMedCrossRefGoogle Scholar
  20. 20.
    Krug EJ, Sharma GK, Lozano R (2000) The global burden of injuries. Am J Publ Health 90:523–526CrossRefGoogle Scholar
  21. 21.
    Mock CN, Adzotor E, Denno D, Conklin E, Rivara F (1995) Admissions for injury at a rural hospital in Ghana: implications for prevention in the developing world. Am J Public Health 85:927–931PubMedCrossRefGoogle Scholar
  22. 22.
    Mock CN, Forjuoh SN, Rivara FP (1999) Epidemiology of transport-related injuries in Ghana. Accid Anal Prev 31:359–370PubMedCrossRefGoogle Scholar
  23. 23.
    Jamison DT, Bank W, Project DCP (2006) Disease control priorities in developing countries. Oxford University Press, OxfordGoogle Scholar
  24. 24.
    Murray CJL, López AD, Health HSoP, Organization WH, Bank W (1996) The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World BankGoogle Scholar
  25. 25.
    London JMC, Abantanga FA, Quansah RE, Boateng KA (2002) Using mortuary statistics in the development of an injury surveillance system in Ghana. Bull World Health Organ 80:357–364PubMedGoogle Scholar
  26. 26.
    Lerner EB, Moscati RM (2001) The golden hour: scientific fact or medical “urban legend”? Acad Emerg Med 8:758–760PubMedCrossRefGoogle Scholar
  27. 27.
    van der Velden MW, Ringburg AN, Bergs EA, Steyerberg EW, Patka P, Schipper IB (2008) Prehospital interventions: time wasted or time saved? An observational cohort study of management in initial trauma care. Emerg Med J 25:444–449PubMedCrossRefGoogle Scholar
  28. 28.
    Sprague S, Leece P, Bhandari M, Tornetta P 3rd, Schemitsch E, Swiontkowski MF (2003) Limiting loss to follow-up in a multicenter randomized trial in orthopedic surgery. Control Clin Trials 24:719–725PubMedGoogle Scholar
  29. 29.
    Pollock DA, McClain PW (1989) Trauma registries, current status and future prospects. JAMA 262:2280–2283PubMedCrossRefGoogle Scholar
  30. 30.
    Schultz CR, Ford HR, Cassidy LD, Shultz BL, Blanc C, King-Schultz LW, Perry HB (2007) Development of a hospital-based trauma registry in Haiti: an approach for improving injury surveillance in developing and resource-poor settings. J Trauma 63:1143–1154PubMedCrossRefGoogle Scholar
  31. 31.
    Adofo K, Donkor P, Boateng KA, Afukaar F, Mock C (2010) Sustainable improvements in injury surveillance in Ghana. Int J Inj Control Saf Promot 17:79–85CrossRefGoogle Scholar
  32. 32.
    Househ M (2011) Sharing sensitive personal health Information through facebook: the unintended consequences. Stud Health Technol Inform 169:616–620PubMedGoogle Scholar
  33. 33.
    Thompson L, Black E, Duff P, Paradise Black N, Saliba H, Dawson K (2011) Protected health information on social networking sites: ethical and legal considerations. J Med Internet Res 13:e8PubMedCrossRefGoogle Scholar
  34. 34.
    Lagu T, Kaufman EJ, Asch DA, Armstrong K (2008) Content of weblogs written by health professionals. J Gen Intern Med 23:1642–1646PubMedCrossRefGoogle Scholar
  35. 35.
    Chretien KC, Greysen SR, Chretien JP, Kind T (2009) Online posting of unprofessional content by medical students. JAMA 302:1309–1315PubMedCrossRefGoogle Scholar
  36. 36.
    Braa K, Purkayastha S (2010) Sustainable mobile information infrastructures in low resource settings. Stud Health Technol Inform 157:127–132PubMedGoogle Scholar
  37. 37.
    Asangansi I, Braa K (2010) The emergence of mobile-supported national health information systems in developing countries. Stud Health Technol Inform 160:540–544PubMedGoogle Scholar
  38. 38.
    Mock C, Nguyen S, Quansah R, Arreola-Risa C, Viradia R, Joshipura M (2006) Evaluation of trauma care capabilities in four countries using the WHO-IATSIC guidelines for essential trauma care. World J Surg 30:946–956. doi: 10.1007/s00268-005-0768-4 PubMedCrossRefGoogle Scholar
  39. 39.
    Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto J, Wangoda R, Mijumbi C, Hsia R, Dicker R, Ozgediz D (2009) Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program. World J Surg 33:2512–2521. doi: 10.1007/s00268-009-0180-6 PubMedCrossRefGoogle Scholar
  40. 40.
    Harirchi I, Ebrahimi M, Zamani N, Jarvandi S, Montazeri A (2000) Breast cancer in Iran: a review of 903 case records. Public Health 114:143–145PubMedGoogle Scholar
  41. 41.
    Murray CJ, Lopez AD, Barofsky JT, Bryson-Cahn C, Lozano R (2007) Estimating population cause-specific mortality fractions from in-hospital mortality: validation of a new method. PLoS Med 4:e326PubMedCrossRefGoogle Scholar
  42. 42.
    Wolfe BA, Mamlin BW, Biondich PG, Fraser HS, Jazayeri D, Allen C, Miranda J, Tierney WM (2006) The OpenMRS system: collaborating toward an open source EMR for developing countries. In: AMIA Annual Symposium proceedings/AMIA Symposium. AMIA Symposium 1146Google Scholar
  43. 43.
    Williams F, Boren SA (2008) The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. Inform prim care 16:139–145PubMedGoogle Scholar
  44. 44.
    Osen H, Chang D, Choo S, Perry H, Hesse A, Abantanga F, McCord C, Chrouser K, Abdullah F (2011) Validation of the World Health Organization tool for situational analysis to assess emergency and essential surgical care at district hospitals in Ghana. World J Surg 35:500–504. doi: 10.1007/s00268-010-0918-1 PubMedCrossRefGoogle Scholar
  45. 45.
    Mkandawire N, Ngulube C, Lavy C (2008) Orthopaedic clinical officer program in Malawi: a model for providing orthopaedic care. Clin Orthop Relat Res 466:2385–2391PubMedCrossRefGoogle Scholar
  46. 46.
    Grimes C, Lavy C (2010) A plea for investment in district hospitals. Lancet 376:2073PubMedCrossRefGoogle Scholar
  47. 47.
    Spiegel DA, Gosselin RA, Coughlin RR, Kushner AL, Bickler SB (2008) Topics in global public health. Clin Orthop Relat Res 466:2377–2384PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Daniel B. Sonshine
    • 1
    • 2
    • 3
    Email author
  • Jesse Shantz
    • 1
    • 2
    • 3
  • Raphael Kumah-Ametepey
    • 3
    • 4
  • R. Richard Coughlin
    • 2
    • 3
  • Richard A. Gosselin
    • 2
    • 3
    • 5
  1. 1.Orthopaedic SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Orthopaedic SurgeryOrthopaedic Trauma InstituteSan FranciscoUSA
  3. 3.Orthopaedic SurgeryInstitute for Global Orthopaedics and TraumatologySan FranciscoUSA
  4. 4.Accident and Emergency Directorate, Trauma and Orthopaedic Surgery, Komfo Anokye Teaching HospitalKumasiGhana
  5. 5.School of Public Health, University of California, BerkeleyBerkeleyUSA

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