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Background: Predisposing factors for traumatic injuries are complex and variable. Neighborhood environments may influence injury mechanism or outcomes. The Social Vulnerability Index (SVI) identifies areas at risk for emergencies; Area Deprivation Index (ADI) measures socioeconomic disadvantage. The objective was to assess the impact of SVI or ADI on hospital length of stay (LOS) and mortality for injured patients to determine whether SVI or ADI indicated areas where injury prevention may be most impactful., Methods: Adult patients who resided in Milwaukee County and were treated for injuries from 2015 to 2022 at a level I trauma center were included. Patients' addresses were geocoded and merged with 2020 state-level SVI and ADI measures. SVI ranks census tracts 0-100 from least to most vulnerable. ADI ranks census block groups 1-10 from least to most disadvantaged. ADI and SVI rankings were converted to deciles. Statistical analyses included descriptive statistics, chi-square tests, and regression models for LOS and in-hospital mortality, adjusted for either SVI or ADI within separate models, age, sex, race or ethnicity, mechanism of injury (MOI), injury severity score (ISS)., Results: 14,542 patients were included; 63 % were male. Mean total hospital LOS was 6.4 ± 9.8 days, and in-hospital mortalities occurred in 5.2 % of patients. Based on SVI and ADI, 5,280 (36 %) patients resided in high vulnerability areas and 5,576 (39 %) lived in highly disadvantaged areas, respectively. After adjusting for patient factors, SVI deciles #6, 9, 10 were associated with increased hospital LOS, and SVI decile #5 was associated with in-hospital mortality (OR = 2.22, 95 %CI:1.06-4.63; p = 0.034). When adjusted for ADI, the 7th-10th deciles were associated with increased hospital LOS. Greater age and ISS were associated with increased hospital LOS and mortality when adjusted for SVI and ADI., Conclusions: SVI and ADI identified a similar proportion of patients in high vulnerability or disadvantaged areas. Higher SVI and ADI deciles were associated with longer hospital LOS, and only the 5th SVI decile was associated with in-hospital mortality. Highly disadvantaged or vulnerable areas may have a longer LOS, but SVI and ADI have limited influence on trauma mortality. Continued research on neighborhood and community factors and trauma outcomes is needed., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background/purpose: This 8-year retrospective study of the National Trauma Data Bank describes temporal trends of traumatic injury by mechanism of injury (MOI) by demographic characteristics from 2012 to 2019 for adult patients 18 years and older., Methods: Overall, 5 630 461 records were included after excluding those with missing demographic information and International Classification of Disease codes. MOIs were calculated as proportions of total injury by year. Temporal trends of MOI were evaluated using two-sided non-parametric Mann-Kendall trend tests for (1) all patients and (2) within racial and ethnic groups (ie, Asian, 2% of total patient sample; Black, 14%; Hispanic or Latino, 10%; Multiracial, 3%; Native American, <1%; Pacific Islander, <1%; White, 69%) and stratified by age and sex., Results/outcomes: For all patients, falls increased over time (p=0.001), whereas burn (p<0.01), cut/pierce (p<0.01), cyclist (p=0.01), machinery (p<0.001), motor vehicle transport (MVT) motorcyclist (p<0.001), MVT occupant (p<0.001) and other blunt trauma (p=0.03) injuries decreased over time. The proportion of falls increased across all racial and ethnic groups and significantly for those aged 65 and older. There were further differences in decreasing trends of MOI by racial and ethnic categories and by age groups., Conclusions: These results suggest that falls are an important injury prevention target with an ageing US population across all racial and ethnic groups. Differing injury profiles by racial and ethnic identity indicate that injury prevention efforts be designed accordingly and targeted specifically to individuals most at risk for specific MOIs., Study Type: Level I, prognostic/epidemiological., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Significant variability exists in the triage of injured children with most systems using mechanism of injury and/or physiologic criteria. It is not well established if existing triage criteria predict the need for intervention or impact morbidity and mortality. This study evaluated existing evidence for pediatric trauma triage. Questions defined a priori were as follows: (1) Do prehospital trauma triage criteria reduce mortality? (2) Do prehospital trauma scoring systems predict outcomes? (3) Do trauma center activation criteria predict outcomes? (4) Do trauma center activation criteria predict need for procedural or operative interventions? (5) Do trauma bay pediatric trauma scoring systems predict outcomes? (6) What secondary triage criteria for transfer of children exist?, Methods: A structured, systematic review was conducted, and multiple databases were queried using search terms related to pediatric trauma triage. The literature search was limited to January 1990 to August 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was applied with the methodological index for nonrandomized studies tool used to assess the quality of included studies. Qualitative analysis was performed., Results: A total of 1,752 articles were screened, and 38 were included in the qualitative analysis. Twelve articles addressed questions 1 and 2, 21 articles addressed question 3 to 5, and five articles addressed question 6. Existing literature suggest that prehospital triage criteria or scoring systems do not predict or reduce mortality, although selected physiologic parameters may. In contrast, hospital trauma activation criteria can predict the need for procedures or surgical intervention and identify patients with higher mortality; again, physiologic signs are more predictive than mechanism of injury. Currently, no standardized secondary triage/transfer protocols exist., Conclusion: Evidence supporting the utility of prehospital triage criteria for injured children is insufficient, while physiology-based trauma system activation criteria do appropriately stratify injured children. The absence of strong evidence supports the need for further prehospital and secondary transfer triage-related research., Level of Evidence: Systematic review study, level II.

Introduction: Pediatric traumatic injury is a major public health concern that is poorly documented in lower and middle-income countries. This study analyzed data on pediatric injuries from a unique hospital trauma registry in Abuja, Nigeria., Methods: Data were analyzed on 220 traumatically injured patients aged 21 years/less to describe injury characteristics and to determine the association between mechanism of injury and pediatric head injuries in Abuja, Nigeria, between 2014 and 2015. Bivariate analysis using Pearson's chi-square and adjusted logistic regression were conducted to characterize the population and identify risk factors for head injury. P-values<0.05 were considered statistically significant. All statistical analyses were performed using STATA v.15.1., Results: The majority of patients were male (60.9%) with a mean age (SD) of 12.5±6.9 years. Head injuries were most common (49.6%), followed by chest (14.1%), abdomen (12.3%) and back (7.7%). The mechanism of injury was statistically significantly associated with head injury (p=0.027) with 63% of children in a motor vehicle accident sustaining a head injury. After adjusting for covariates, the odds of head injury were 3.8 times higher for children injured in a motor vehicle accidents (MVA) compared to those with falls (95%CI 1.40-10.40)., Conclusion: This analysis reveals that motor vehicle accident is a risk factor for traumatic head injury among children in Nigeria. Therefore, efforts should be made to address motor vehicle accidents involving children. These data will help to inform age-related prevention and treatment strategies. The results of this study highlight the importance of collecting pediatric trauma data in developing countries., Competing Interests: The authors declare no competing interests., (© Abdul Rahman Shour et al.)

Introduction: Venous thromboembolism (VTE) is increasingly prevalent in injured children admitted to the intensive care unit (ICU). Few data exist to support VTE pharmacologic prophylaxis or ultrasound (US) surveillance in children with high bleeding risk. After implementation of screening US guidelines, we sought to describe our experience, hypothesizing that screening US of children at highest risk for VTE results in earlier detection and management., Study Design: A retrospective analysis was conducted on prospectively collected data of injured children admitted to an American College of Surgeons Verified level 1 Pediatric Trauma Center from 2010 to 2015. In patients at high risk for both VTE and bleeding (HRHR), guidelines recommended deferral of pharmacologic prophylaxis and a screening US at ≥7 ICU days if bleeding risk remained. Outcomes analyzed included VTE rates, guideline compliance, and US timing. The rate of deep vein thrombosis (DVT) detection (number of DVT captured/number of US obtained) was examined., Results: Of 4061 trauma patients, 588 (14.5%) were critically injured including 112 patients who met HRHR criteria. The rate of VTE in the HRHR group ≥7 ICU days was 25% (14/56). Of 23 VTE diagnosed in the ICU, 17 were detected by 49 US performed (34.7%), with the remaining 6 diagnosed by computed tomography. DVT was detected earlier than the US guideline recommended 7 days, independent of symptoms. Guideline compliance was 86%., Conclusion: Critically injured children at risk for bleeding frequently develop VTE. Surveillance ultrasound in patients at high risk for both VTE and bleeding allows earlier detection and treatment., Level of Evidence: Therapeutic study, level II., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Assault is the most common form of intentional injury resulting in pediatric death. This large retrospective study analyzed statewide data from the Ohio Trauma Registry (87% of the state's hospitals) to describe risk factors of assault for pediatric trauma patients., Methods: Of 16,938 pediatric trauma patients younger than 16 years in the state trauma registry, assault was identified in 758 patients. Patients with assault injuries and nonassault injuries were compared using χ2 tests. Multiple logistic regression evaluated associations between assault and mortality, adjusting for potential confounders. Results of the regression analyses are reported as odds ratios (OR) with 95% confidence intervals., Results: Children younger than 1 year were 5 times more likely to be assaulted (OR, 5.34; 95% CI, 4.14-6.88) compared to children 14 to 15 years old, and black children had 3 times the risk compared to white children (OR, 3.36; 95% CI, 2.79-4.04). Children with government insurance were 3 times more likely to be assaulted compared to children with commercial insurance (OR, 3.00; 95% CI, 2.23-4.04). Assault victims were twice as likely arrive at the first hospital of care over 24 hours after injury (OR, 1.95; 95% CI, 1.44-2.66). Assault victims were more likely to die after adjusting for injury severity., Conclusion: Assault victims experience delays in care and had twice the mortality rate after adjusting for injury severity. The worse outcomes for pediatric assault victims highlight the importance of accurately diagnosing and intervening.

Background: Despite significant advances in the prevention and treatment of pediatric trauma, preventable injuries continue to burden the lives of millions of children. To target prevention strategies, it is critical to identify areas with high burdens of pediatric trauma. Therefore, this study analyzed statewide data from the Ohio Trauma Registry from 2007 to 2012 to identify geographical patterns in pediatric injury., Methods: Data from the first hospital of care for 16,330 pediatric trauma patients younger than 16 years were analyzed using the disease mapping method adaptive spatial filtering to estimate a series of maps that display age- and sex-adjusted rates of pediatric trauma, severe trauma, and standardized mortality ratios while controlling for population size to create stable estimates throughout the study area. The locations of all trauma centers were mapped to highlight access to trauma care., Results: Areas with significantly higher than expected rates of severe injury were identified in nonurban areas, where children lacked timely access to a pediatric trauma center or Level I adult trauma center. Although highest standardized mortality ratios were in urban areas, nonurban areas experienced elevated mortality with rates over four times higher than expected., Conclusion: Areas with higher than expected age- and sex-adjusted rates of severe injury and mortality should be further explored to identify opportunities for injury prevention and appropriate access to timely care., Level of Evidence: Epidemiologic study, level III.

Background: Pharmacologic prophylaxis for venous thromboembolism (VTE) is a widely accepted practice in adult trauma patients to prevent associated morbidity and mortality. However, VTE prophylaxis has not been standardized in injured pediatric patients. Our institution identified factors potentially associated with a high risk of VTE in critically injured children that led to prospective implementation of VTE prophylaxis guidelines. We hypothesize that the guidelines are accurate in predicting children at risk for VTE., Methods: Data were prospectively collected on injured children from August 2010 to August 2015. Pharmacologic prophylaxis was indicated for patients identified by the guidelines as high risk for VTE. Prophylaxis was deferred and a screening ultrasound was performed if the high-risk VTE patients were also at high risk for bleeding. To assess the accuracy of predicting confirmed cases of VTE, stepwise logistic regression analysis was used to measure the association of individual risk factors with VTE controlling for age (≥13 years). A receiver operating characteristic curve measured the accuracy of the final model to predict a VTE., Results: Of 4,061 trauma patients, 588 were admitted to the ICU, with the guidelines identifying 199 as high risk for VTE. VTE occurred in 3.9% (23/588) of the ICU population and 10% (20/199) of the high risk group. The median age of VTE patients in the ICU was 9.7 years. Statistically significant predictors (p < 0.05) of VTE in the multivariate model included presence of a central venous catheter (OR = 5.2), inotropes (OR = 7.7), immobilization (OR = 5.5), and a Glasgow Coma Scale of <9 (OR = 1.3). The area under receiver operating characteristic curve of this model was 0.92, demonstrating its excellent predictive ability., Conclusion: Specific clinical factors in critically injured children are associated with a high risk for VTE. Incorporating these risk factors in VTE prophylaxis guidelines facilitates more accurate risk stratification and may allow for improved VTE prevention in pediatric trauma., Level of Evidence: Prognostic study, level II.

Background: More than 90% of injury-related deaths and disabilities occur in low- and middle-income countries. The development of the Nigerian Trauma Registry (NTR) and the first descriptive data analysis of the patient characteristics, mechanisms of injury, injury severity, and treatments are reported., Methods: Existing data collection tools were modified to capture a minimum data set of variables reflective of the trauma experience in Nigeria. Data are collected using the secure, Web-based application, REDCap (Research Electronic Data Capture)., Results: Two hospitals entered 564 patients into the registry. Motor vehicle accidents were the most frequently reported trauma (69.2%). Of the 51 fall injuries, 82% were from buildings. There were 229 mass casualties, including bus accidents (41.5%), bombings or blasts (28.8%), multiple vehicle accidents (23.6%), fires (3.1%), and civil conflicts or riots (3.1%). External soft tissue was the most commonly reported injury region followed by extremities, head and neck, face, abdomen, and thorax/spine. Only 18.1% of patients arrived by ambulance. There were 19 recorded in-hospital deaths and 79.0% of these were due to motor vehicle accidents., Conclusions: This is the largest report of injury surveillance in this country. These data are essential to inform policy makers about the increasing trauma burden and provide a strong advocacy tool, prevention opportunities, provisions for unmet capacity needs, and better allocation of limited health care resources. The NTR has demonstrated that development and implementation of an electronic trauma registry is feasible in low- and middle-income countries. The NTR evolved through international collaborations that included a partnership with an American epidemiologist and 2 Nigerian hospitals that contributed their individual and institutional capabilities. Local champions are required to drive the initiation and implementation of registries.

Background: Timely access to the appropriate level of care, both in the prehospital and in the hospital setting, is necessary to optimize outcomes in severely injured pediatric trauma patients. However, a substantial portion of the pediatric population does not have adequate timely access to a verified Level 1 trauma center. This study aimed to identify significant predictors of in-hospital mortality and transfer to a higher level of care. This is the first statewide analysis that includes pediatric patients who are first seen at nontrauma centers (NTCs)., Methods: Mortality interhospital transfers to a higher level of care were analyzed for the first hospital of care. Clustering was accounted for by generalized estimating equations. p < 0.01 was considered significant., Results: Younger age was significantly associated with mortality for all patients and with transfer for less severely injured children (Injury Severity Score [ISS] < 15). The odds of mortality in NTCs were lower than in Level 1 trauma centers; however, the majority of NTC patients were transferred, artificially decreasing NTC mortality. The type of trauma (blunt or penetrating) was significantly associated with both mortality and transfer for more severe cases. Although insurance was not significantly associated with transfer, self-pay patients had significantly higher mortality odds., Conclusion: The NTCs are transferring 98% of their patients, even those with very low ISS and high Glasgow Coma Scale (GCS). Further evaluation of the outcomes and characteristics of patients transferred from NTCs will provide important information to inform the triage guidelines to potentially safely avoid transfer of less severely injured patients from NTCs in their community., Level of Evidence: Therapeutic study, level IV; epidemiologic/prognostic study, level III.

Background/purpose: Researchers are constantly challenged to identify optimal mortality risk adjustment methodologies that perform accurately in pediatric trauma patients. This study evaluated the new Trauma Mortality Prediction Model (TMPM-ICD-9) in pediatric trauma patients., Methods: Data were analyzed on 107,104 pediatric trauma patients included in the NTDB® in 2010 who had both a valid ISS and probability of death using TMPM-ICD-9. Discrimination was compared using the area under the receiver operator characteristic curve (AUC) and by age, blunt vs penetrating, intent, Glasgow Coma Scale (GCS), and number of injuries., Results: The AUC for TMPM-ICD-9 demonstrated excellent discrimination in predicting mortality versus ISS overall, 11 to 17years of age (0.96 vs 0.93), by injury type, intent, and in the lowest GCS scores. The TMPM-ICD-9 showed superior discrimination over ISS in patients with more than two injuries., Conclusions: The TMPM demonstrated superior discrimination compared to ISS. The TMPM shows promise of a much needed and simple to use risk adjustment tool with application to both adult and pediatric patients. Researchers should continue to validate this tool in robust pediatric data sets., (© 2014.)

Background: Information regarding the use of negative pressure wound therapy (NPWT) in the pediatric population is limited. Because of adverse outcomes in adult patients, the Food and Drug Administration issued a warning in 2011 about the use of NPWT in infants and children., Methods: We performed an institutional review board-approved, single-institution, retrospective review of pediatric patients who had undergone NPWT from 2007-2011. We collected the types of wounds for which NPWT was initiated, the NPWT outcomes, and the complications encountered., Results: The data from 290 consecutive patients were reviewed. Their average age was 9.3 y (range 12 d to 18 y), and their average weight was 46.5 kg (range 1.1-177). Of the wounds, 66% were classified as acute, 10% as chronic, and 24% as traumatic. The two most common indications were surgical wound dehiscence (n = 47) and skin grafting (n = 41). NPWT was used in 15 wounds containing surgical hardware, with 2 devices requiring eventual removal. NPWT was used for a median of 9 d per patient (two dressing changes). Complications occurred in 5 patients (1.7%). Documentation problems were noted in 44 patients. After NPWT, about one-third of the patients (n = 95 patients) were able to undergo delayed primary closure., Conclusions: NPWT is an effective adjunct in wound healing and closure in the pediatric population, with no mortality ascribed to NPWT. Also, the complication rates were low., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Injury is the leading cause of childhood morbidity and mortality in the US. The associated costs exceed $20 billion annually. This study examined disparities in disadvantaged populations of critically injured pediatric patients admitted to a level 1 pediatric trauma center., Study Design: A retrospective study was conducted of all trauma patients admitted to the pediatric intensive care unit (PICU) at a level 1 pediatric trauma hospital from 2005 to 2009., Results: Data on 324 patients were analyzed; 45% of patients were Caucasian, 33% were African American, 12% were Hispanic, and 10% were other. There was no difference in age, Glasgow Coma Scale (GCS), or Injury Severity Score (ISS) across ethnic groups. The mortality rate was 12%. A higher percentage of Caucasians were commercially insured and from the highest income quartile than non-Caucasians (p < 0.001). African Americans had the highest rate of penetrating trauma and intentional injury compared with other ethnicities (p < 0.001). Nearly 75% of firearm injuries were clustered in 7 ZIP codes with the lowest median household incomes. The home was the most common location for firearm injuries. Children involved in assaults were more likely to have a single parent (67%) than 2 parents (26%, p < 0.001). Both ethnicity and payer status were significantly associated with mortality., Conclusions: Significant disparities in socioeconomic status exist in severely injured pediatric patients treated in the PICU. Disparities were associated with adverse outcomes. These results should inform community and public health efforts to identify the areas and populations at highest risk for violence-related injuries., (Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: To use a nationwide household survey tool to provide an estimate of injury prevalence, mechanisms of traumatic injuries, and number of injury-related deaths in a low-income country., Design: A randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool was conducted in 2012., Setting: Sierra Leone, Africa., Participants: Three thousand seven hundred fifty randomly selected participants throughout Sierra Leone., Main Outcome Measures: Mechanisms of injury based on age, sex, anatomic location, cause, and sociodemographic factors as well as mechanisms of injury-related deaths in the previous year were the primary outcome measures., Results: Data were collected and analyzed from 1843 households and 3645 respondents (98% response rate). Four hundred fifty-two respondents (12%) reported at least 1 traumatic injury in the preceding year. Falls were the most common cause of nonfatal injuries (40%). The extremities were the most common injury site regardless of age or sex. Traffic injuries were the leading cause of injury-related deaths (32% of fatal injuries)., Conclusions: This study provides baseline data on the mechanisms of traumatic injuries as well as the sociodemographic factors affecting injury prevalence in one of the world's poorest nations. It is anticipated that these data will provide an impetus for further studies to determine injury severity, associated disability, and barriers to accessing care in these resource-poor areas.

Background: The National Trauma Data Bank (NTDB) was developed as a convenience sample of registry data from contributing trauma centers (TCs), thus, inferences about trauma patients may not be valid at the national level. The NTDB National Sample was created to obtain nationally representative estimates of trauma patients treated in the US level I and II TCs., Methods: Level I and II TCs in the Trauma Information Exchange Program were identified and a random stratified sample of 100 TCs was selected. The probability-proportional-to-size method was used to select TCs and sample weights were calculated. National Sample Program estimates from 2003 to 2006 were compared with raw NTDB data, and to a subset of TCs in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a population-based dataset drawn from community hospitals., Results: Weighted estimates from the NTDB National Sample range from 484,000 (2004) to 608,000 (2006) trauma incidents. Crude NTDB data over-represented the proportion of younger patients (0 years-14 years) compared with the NTDB National Sample, which does not include children's hospitals. Few TCs in Trauma Information Exchange Program are included in Healthcare Cost and Utilization Project Nationwide Inpatient Sample, but estimates based on this subset indicate a higher percentage of older patients (age 65 year or older, 23.98% versus 17.85%), lower percentage male patients, and a lower percentage of motor vehicle accidents compared with NTDB National Sample., Conclusion: Although nationally representative data regarding trauma patients are available in other population-based samples, they do not represent TCs patients and lack the specificity of National Sample Program data, which contains detailed information on injury mechanisms, diagnoses, and hospital treatment.

Background: Improving trauma care and preparing for a disaster require data collection and analysis. Trauma registries capture data for research, measure trauma system outcomes, and support quality improvement through assessment of the appropriateness and effectiveness of the trauma system., Methods: The purpose of this article is to evaluate the role of trauma registries in disaster planning for the pediatric population by: (1) describing the history and current state of pediatric trauma registries; (2) providing examples of functioning trauma registries and their application to assist in disaster planning; and (3) a summary of the applicability to pediatric disaster planning as well as recommendations for future efforts., Results: The National Pediatric Trauma Registry was discontinued in 2002. A detailed plan and design have been developed for the National Trauma Registry for Children; however, the funding has not been available to implement. The National Trauma Data Bank is the largest repository of trauma records in the United States; however, it has not focused specifically on pediatric data collection. The most highly reported use of trauma registry data for studying mass casualties and disaster planning has been conducted outside of the United States and related to terrorist attacks., Conclusions: Aggregating existing data from state trauma registries or using the National Trauma Data Bank may facilitate development of statistical models to help predict survival, injury patterns, and important physiological thresholds. However, representative pediatric-specific trauma registry data are needed to obtain an adequate sample size in pediatric population to extrapolate data to represent the scale of a disaster.

Before beginning a study of trauma care for children, it is necessary to understand contemporary injury patterns of children, specifically the volume and types of injury, injury severity, and institutions where children are hospitalized for trauma. This article was designed to address these issues using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) 2003 that contains over 7 million discharge records from hospitalized children in the United States. Our classification of hospitals into pediatric experience and trauma experience are a first step in better defining what hospital characteristics are important to the optimal care of an injured child. In an era of limited resources, we would like to assure that the right child received the right treatment at the right place.

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.

Background: This study was undertaken to assess the current status of statewide trauma registries to facilitate a design and plans for a National Trauma Registry for Children., Methods: A telephone survey was administered to state EMS or state trauma registry managers. Summary data for each state was compiled and state EMS or trauma registry managers reviewed the information for accuracy. Survey findings were compared with findings from a similar survey conducted in 1992., Results: Thirty-two states reported an active state trauma registry, an increase of seven states since 1992. Thirteen additional states and the District of Columbia are discussing or planning the development of a state trauma registry. One state had a registry but hospitals were not submitting data at the time of this survey. Only four states have no plans to develop a trauma registry. Twenty-nine states with registries require all hospitals to submit data; 15 of these obtain data from trauma centers only. The most commonly reported uses for trauma registry data include advocacy, injury surveillance, education and training, and research. The least commonly reported use is for reimbursement analysis., Conclusion: Since 1992, progress has been made in developing state trauma registries. Although the concept of a national trauma registry data collection based upon 45 existing state registries, as well as from the District of Columbia, is appealing, concerns about data comparability require resolution. Furthermore, additional work would be required to create a representative sample from which national estimates of injury or outcome could be based.

Background: Statewide trauma registries have proliferated in the last decade, suggesting that information could be aggregated to provide an accurate depiction of serious injury in the United States., Objectives: To determine whether variability exists in the composition and content of statewide trauma registries, specifically addressing case-acquisition, case-definition (inclusion criteria), and registry-coding conventions., Methods: A cross-sectional, two-part survey was administered to managers of all statewide trauma registries. State trauma registrars also provided inclusion and exclusion criteria from their state registry and abstracted a clinical vignette designed to identify coding inconsistencies., Results: Thirty-two states maintain a centralized registry, but requirements for data submission vary significantly. Inclusion and exclusion criteria also vary, particularly for nontraumatic injuries. Coding conventions adopted by states for vague or missing information are dissimilar. When abstractions of the clinical vignette are compared, only 19% and 47% of states provided similar quantity or content for injury e-coding and diagnostic coding, respectively. Injury severity scores (based on diagnostic coding) demonstrated a range from 2 to 18., Conclusions: Statewide trauma registries are prevalent but vary significantly in composition and content. Standardizing inclusion criteria, variable definitions, and coding conventions would greatly enhance the usability of an aggregated, national trauma registry.

Injury is still the number 1 killer of children ages 1 to 18 years in the United States (http://www.cdc.gov/nchs/fastats/children.htm). Children who sustain injuries with resulting disabilities incur significant costs not only for their health care but also for productivity lost to the economy. The families of children who survive childhood injury with disability face years of emotional and financial hardship, along with a significant societal burden. The entire process of managing childhood injury is enormously complex and varies by region. Only the comprehensive cooperation of a broadly diverse trauma team will have a significant effect on improving the care of injured children.