Development of a hospital-based trauma registry in Haiti: an approach for improving injury surveillance in developing and resource-poor settings

Abstract

Background: Trauma-related morbidity and mortality are a growing burden in the developing world. However, usable injury data in resource-poor and developing settings is lacking. Trauma registries can improve injury surveillance to enhance trauma care, outcomes, and prevention. This article provides, by example from Haiti, an approach to developing a hospital-based trauma registry in a resource-poor setting.

Methods: An assessment of trauma documentation was performed retrospectively with subsequent development and pilot testing of two injury surveillance systems. The system most promising for meeting the needs and capabilities of the institution was implemented.

Results: Retrospective medical record review from 1999 (n = 43) and 2002 (n = 43) revealed limitations in available data for trauma surveillance. Specific mechanism of injury was documented in 39.3% and 57.1% of 1999 and 2002 groups, respectively. Injury date and arrival vital signs were infrequently recorded. Two injury surveillance models were designed and pilot tested: provider-based (PTR) (pilot n = 19) and coordinator-based (CTR) (pilot n = 37) trauma registries. Analysis of the pilot testing resulted in revisions to operations and the trauma registry forms. Both registry models showed improved data collection compared with the retrospective study with CTR and PTR documenting specific mechanism of injury in 94.6% and 100% of patients, respectively. The PTR model was chosen for implementation at the hospital.

Conclusions: Trauma registries in developing settings are plausible tools for injury surveillance. Successful trauma registries will be resource- and setting-specific in design and can potentially be the means by which trauma care and outcomes are improved, prevention programs are developed, and capacity-building goals realized.