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Background: Comparisons across trauma systems are key to identifying opportunities to improve trauma care. We aimed to compare trauma service structures, processes and outcomes between the English National Health Service (NHS) and the province of Quebec, Canada. Methods: We conducted a multicentre cohort study including admissions of patients aged older than 15 years with major trauma to major trauma centres (MTCs) from 2014/15 to 2016/17. We compared structures descriptively, and time to MTC and time in the emergency department (ED) using Wilcoxon tests. We compared mortality, and hospital and intensive care unit (ICU) length of stay (LOS) using multilevel logistic regression with propensity score adjustment, stratified by body region of the worst injury. Results: The sample comprised 36 337 patients from the NHS and 6484 patients from Quebec. Structural differences in the NHS included advanced prehospital medical teams (v. 'scoop and run' in Quebec), helicopter transport (v. fixed-wing aircraft) and trauma team leaders. The median time to an MTC was shorter in Quebec than in the NHS for direct transports (1 h v. 1.5 h, p < 0.001) but longer for transfers (2.5 h v. 6 h, p < 0.001). Time in the ED was longer in Quebec than in the NHS (6.5 h v. 4.0 h, p < 0.001). The adjusted odds of death were higher in Quebec for head injury (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.09-1.51) but lower for thoracoabdominal injuries (OR 0.69, 95% CI 0.52-0.90). The adjusted median hospital LOS was longer for spine, torso and extremity injuries in the NHS than in Quebec, and the median ICU LOS was longer for spine injuries. Conclusion: We observed significant differences in the structure of trauma care, delays in access and risk-adjusted outcomes between Quebec and the NHS. Future research should assess associations between structures, processes and outcomes to identify opportunities for quality improvement. Contexte : Il est indispensable de comparer entre eux les différents systèmes intégrés de traumatologie pour identifier les secteurs où les soins peuvent y être améliorés. Nous avons donc procédé à une comparaison descriptive des structures, du fonctionnement et des résultats entre le National Health Service (NHS) du Royaume-Uni et le Québec, au Canada. Méthodes : Nous avons réalisé une étude de cohorte multicentrique regroupant des victimes de traumatismes majeurs âgées de 15 ans et plus hospitalisées dans de grands centres intégrés de traumatologie (CIT) de 2014/15 à 2016/17. Nous avons procédé à une comparaison descriptive des structures, de l'intervalle médian avant l'arrivée au CIT et de la durée du séjour aux urgences à l'aide de tests de Wilcoxon. Nous avons comparé la mortalité et la durée des séjours à l'hôpital et à l'unité de soins intensifs (USI) par analyse de régression logistique multiniveau avec redressement des scores de propension stratifiée selon les structures anatomiques les plus gravement touchées. Résultats : L'échantillon comprenait 36 337 cas du NHS et 6484 cas du Québec. Les différences structurelles du NHS incluaient des équipes médicales de soins préhospitaliers d'urgence avancés (c. transport rapide vers un CIT [<< scoop and run >>] au Québec), le transport par hélicoptère (c. avion à voilure fixe) et des chefs d'équipes de traumatologie. L'intervalle médian avant l'arrivée au CIT a été plus court au Québec par rapport au NHS pour les transports directs (1 h c. 1,5 h, p < 0,001), mais plus long pour les transferts (2,5 h c. 6 h, p < 0,001). La durée du séjour aux urgences a été plus longue au Québec par rapport au NHS (6,5 h c. 4,0 h, p < 0,001). Le risque de mortalité ajusté a été plus élevé au Québec dans les cas de traumatisme crânien (rapport des cotes [RC] 1,28, intervalle de confiance de 95 % [IC] 1,09-1,51), mais moins élevé dans les cas de traumatisme thoraco-abdominal (RC 0,69, IC de 95 % 0,52-0,90). La durée médiane ajustée des séjours hospitaliers a été plus longue dans les cas de traumatisme à la colonne vertébrale, aux membres et au thorax avec le NHS qu'au Québec, et la durée médiane des séjours à l'USI a été plus longue dans les cas de traumatisme à la colonne vertébrale. Conclusion : Nous avons observé des différences significatives quant à la structure des soins en traumatologie, quant aux délais pour y accéder et quant aux résultats ajustés en fonction du risque entre le Québec et le NHS. La recherche future devrait se pencher sur les liens entre les structures, le fonctionnement et les résultats afin de mieux cibler les secteurs où il serait possible d'apporter des améliorations., Injuries are a major public health issue. They represent the primary cause of death for people younger than 40 years, as well as loss of active life years and temporary [...]

BACKGROUND:Trauma registries (TRs) are essential to informing the quality of trauma care within health systems. Lack of standardised trauma documentation is a major cause of inconsistent and poor availability of trauma data in most low- and middle-income countries (LMICs), hindering the development of TRs in these regions. We explored health providers' perceptions on the use of a standardised trauma form to record trauma patient information in Tanzania. METHODS:An exploratory qualitative research using a semi-structured interview guide was carried out to purposefully selected key informants comprising of healthcare providers working in Emergency Units and surgical disciplines in five regional hospitals in Tanzania. Data were analysed using a thematic analysis approach to identify key themes surrounding potential implementation of the standardised trauma form. RESULTS:Thirty-three healthcare providers participated, the majority of whom had no experience in the use of standardised charting. Only five respondents had prior experience with trauma forms. Responses fell into three themes: perspectives on the concept of a standardised trauma form, potential benefits of a trauma form, and concerns regarding successful and sustainable implementation. CONCLUSION:Findings of this study revealed wide healthcare provider acceptance of moving towards standardised clinical documentation for trauma patients. Successful implementation likely depends on the perceived benefits of using a trauma form as a tool to guide clinical management, standardise care and standardise data reporting; however, it will be important moving forward to factor concerns brought up in this study. Potential barriers to successful and sustainable implementation of the form, including the need for training and tailoring of form to match existing resources and knowledge of providers, must be considered.

BackgroundIn Tanzania, there is no national trauma registry. The World Health Organization (WHO) has developed a data set for injury that specifies the variables necessary for documenting the burden of injury and patient-related clinical processes. As a first step in developing and implementing a national Trauma Registry, we determined how well hospitals currently capture the variables that are specified in the WHO injury set.MethodsThis was a prospective, observational cross-sectional study of all trauma patients conducted in the Emergency Units of five regional referral hospitals in Tanzania from February 2018 to July 2018. Research assistants observed the provision of clinical care in the EU for all patients, and documented performed assessment, clinical interventions and final disposition. Research assistants used a purposefully designed case report form to audit the injury variable capture rate, and to review Ministry of Health (MoH) issued facility Register book recording the documentation of variables. We present descriptive statistics for hospital characteristics, patient volume, facility infrastructure, and capture rate of trauma variables.ResultsDuring the study period, 2891 (9.3%) patients presented with trauma-related complaints, 70.7% were male. Overall, the capture rate of all variables was 33.6%. Documentation was most complete for demographics 71.6%, while initial clinical condition, and details of injury were documented in 20.5 and 20.8% respectively. There was no documentation for the care prior to Emergency Unit arrival in all hospitals. 1430 (49.5%) of all trauma-related visits seen were documented in the facility Health Management Information System register submitted to the MoH. Among the cases reported in the register book, the date of EU care was correctly documented in 77% cases, age 43.6%, diagnosis 66.7%, and outcome in 38.9% cases. Among the observed procedures, initial clinical condition (28.7%), interventions at Emergency Unit (52.1%), investigations (49.0%), and disposition (62.9%) were documented in the clinical charts.ConclusionsIn the regional hospitals of Tanzania, there is inadequate documentation of the minimum trauma variables specified in the WHO injury data set. Reasons for this are unclear, but will need to be addressed in order to improve documentation to inform a national injury registry.