Our Projects: (1) Trauma Registry System

A Brief Introduction to Trauma Registry Systems:

Trauma registry systems (TRS) are a formal component of trauma systems in the United States, but have yet to become prevalent in the developing world.  Since its inception in 1969 (at Cook County Hospital in Chicago, no less!), the TRS has developed into a powerful tool for advancing trauma care in such areas as epidemiology, injury control, acute trauma care, quality improvement, research, education, and resource allocation.

While the US has since developed a national TRS, such a complex system is not easily transposed into the healthcare systems of the developing world.  As a result, the Panamerican Trauma Society has developed a comprehensive registry specifically for use in developing countries and has had great success implementing it throughout Latin America.  This TRS not only improves patient care and outcomes in these regions, but also serves as a foundation for public health policy and the development of a trauma care system specific to each environment.

Bolivia’s roadways — especially the infamous “Death Road” — kill thousands every year, with countless more injured. Despite the incredible toll traumatic death/injury has on the country, there currently exists no formal data system to record and analyze trauma in Bolivia.

Aim 1: Develop a Trauma Registry System in Bolivia

For our first project, we are working in partnership with the Panamerican Trauma Society to implement a TRS at Hospital Arco Iris (HAI).  While this was a project I initially dreamt of bringing to La Paz last summer, little did I know that the hospital directors had long hoped to develop a registry at HAI!  Thus, with overwhelming support from the hospital director and directors of surgery, orthopedics/trauma, and emergency medicine, we have already begun the implementation stage and are working to develop a sustainable model for accurate data collection and entry.  As this will be the very first trauma registry in the country, we will be using the next 3 months to gather data in an attempt to gain official governmental support to continue the registry.

Since the above description may not excite you as much as it does our team and the hospital staff, let me provide some practical context:

• As noted in previous posts, horrific fatalities from mass-transit accidents occur in Bolivia nearly every week.  While we know that there is a problem, we do not have a system to quantify and qualify the problem.  Rather, we simply read the news and try to piece everything together.  A trauma registry will allow us to quantify not only how many traumas occur, but also what types, where and to whom, involvement of alcohol/drugs, etc.  There are over 200 data points that will be collected for each trauma patient, providing a wealth of information that can be used to develop future interventions in order to prevent traumas from occurring in the first place.
• Furthermore, while the epidemic of trauma here in Bolivia requires preventative measures, there is also a deficit of quality pre-hospital and in-hospital trauma care.  A trauma registry will allow us to record and analyze every step in patient care between injury, hospital transportation, the emergency department, hospital admission, and death/discharge. With this information, we can then develop quality improvement interventions to give trauma victims the best chance at survival.

This is simply the tip-of-the-iceberg for what can potentially be done with the information provided by a trauma registry system.  For us, it is an exciting start to developing evidence-based interventions that we hope will serve as the foundation for a better trauma system here in Bolivia.