Injury, Int. J. Care Injured 45S (2014) S1
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Editorial
The outstanding achievements of the TraumaRegister of the German Trauma Society (TR-DGU) over the past two decades are documented convincingly in this supplement of Injury. The authors are well known internationally for their timely contributions to care of the injured patient. Initially driven by a small group of passionate individuals to improve the objective description of individual patient injuries; i.e., trauma scoring, the cooperative has expanded enormously in scope as well as beyond the boundaries of Germany. To some degree, the maturation parallels the US process that began as the Major Trauma Outcome Study (MTOS), evolved into the National Trauma Data Bank (NTDB), and now is the Trauma Quality Improvement Program (TQIP) for North America. The leadership of TR-DGU has identified at least three primary goals: (1) characterise trauma epidemiology over time, (2) provide a comprehensive trauma improvement program, and (3) develop a data bank for scientific evaluation. The list of publications in the supplement attests to success with these ambitions as they span issues including trauma system development, pre-hospital care, shock resuscitation, trauma induced coagulopathy, multisystem injury assessment, pelvic fracture management, and long term functional outcome. The breadth of topics is impressive and suggests this list represents only the surface of the potential value of the registry. Trauma registries are most meaningful when they encompass the experience from a large geographic area that provides a sufficient number of patients to enable statistically valid analyses. Germany is recognised for its comprehensive nationwide trauma system and, thus, is positioned well to develop such a registry that could serve as an international benchmark. But the registry is only as good as its data. Herein lie the challenges of maintaining the most useful construct, a lesson learned slowly in the US experience.
http://dx.doi.org/10.1016/j.injury.2014.08.008 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.
First, the data must be valid to ensure the quality of the analyses. Anonymity for individual centre performance has been accomplished by the TR-DGU, but what will motivate future stakeholders to submit accurate information aside from the original altruistic motivation of the founders. Ultimately, obtaining quality data requires resources, and this should ideally become a trauma system financial responsibility. A related issue, of course, is the magnitude of data collected. While the advent of electronic medical systems should facilitate data acquisition, someone must enter accurate data into the system in a time specific manner. For example, risk adjustment for outcome assessment requires systematic documentation of comorbidities, and addressing the ongoing debate of optimal massive transfusion protocols demands the precise timing and quantity of blood component administration as well as coagulation status in response to these interventions. On the other hand, eliminating meaningless data will be important to match the reality of limited funding for standard trauma registries. Perhaps there should be an international effort to define a minimal data set for trauma registries with the anticipation that more comprehensive modules will be required for specific research questions. Irrespective of these issues, the German Trauma Society should be commended for its very productive and invaluable Registry.
Ernest E. Moore Denver, CO, USA
E-mail address: [email protected] (E.E. Moore).
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Editorial
The outstanding achievements of the TraumaRegister of the German Trauma Society (TR-DGU) over the past two decades are documented convincingly in this supplement of Injury. The authors are well known internationally for their timely contributions to care of the injured patient. Initially driven by a small group of passionate individuals to improve the objective description of individual patient injuries; i.e., trauma scoring, the cooperative has expanded enormously in scope as well as beyond the boundaries of Germany. To some degree, the maturation parallels the US process that began as the Major Trauma Outcome Study (MTOS), evolved into the National Trauma Data Bank (NTDB), and now is the Trauma Quality Improvement Program (TQIP) for North America. The leadership of TR-DGU has identified at least three primary goals: (1) characterise trauma epidemiology over time, (2) provide a comprehensive trauma improvement program, and (3) develop a data bank for scientific evaluation. The list of publications in the supplement attests to success with these ambitions as they span issues including trauma system development, pre-hospital care, shock resuscitation, trauma induced coagulopathy, multisystem injury assessment, pelvic fracture management, and long term functional outcome. The breadth of topics is impressive and suggests this list represents only the surface of the potential value of the registry. Trauma registries are most meaningful when they encompass the experience from a large geographic area that provides a sufficient number of patients to enable statistically valid analyses. Germany is recognised for its comprehensive nationwide trauma system and, thus, is positioned well to develop such a registry that could serve as an international benchmark. But the registry is only as good as its data. Herein lie the challenges of maintaining the most useful construct, a lesson learned slowly in the US experience.
http://dx.doi.org/10.1016/j.injury.2014.08.008 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.
First, the data must be valid to ensure the quality of the analyses. Anonymity for individual centre performance has been accomplished by the TR-DGU, but what will motivate future stakeholders to submit accurate information aside from the original altruistic motivation of the founders. Ultimately, obtaining quality data requires resources, and this should ideally become a trauma system financial responsibility. A related issue, of course, is the magnitude of data collected. While the advent of electronic medical systems should facilitate data acquisition, someone must enter accurate data into the system in a time specific manner. For example, risk adjustment for outcome assessment requires systematic documentation of comorbidities, and addressing the ongoing debate of optimal massive transfusion protocols demands the precise timing and quantity of blood component administration as well as coagulation status in response to these interventions. On the other hand, eliminating meaningless data will be important to match the reality of limited funding for standard trauma registries. Perhaps there should be an international effort to define a minimal data set for trauma registries with the anticipation that more comprehensive modules will be required for specific research questions. Irrespective of these issues, the German Trauma Society should be commended for its very productive and invaluable Registry.
Ernest E. Moore Denver, CO, USA
E-mail address: [email protected] (E.E. Moore).
