الفهرس 
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Abstract
Summary
Injuries account for 10% of the global burden of disease, resulting in approximately 5.8 million deaths annually While global morbidity and mortality from trauma has declined significantly since 1990, most of these improvements have been seen in high-income countries. Since 2004, the World Health Organization has advocated for improved trauma care particularly in low- and middle-income countries (LMIC) where trauma results in disproportionately high morbidity and mortality rates. One of the efforts is the Trauma registries (TRs), TRs are databases used to monitor and enhance the quality of trauma care and public health programs related to injury prevention and research. The scope of a particular TR determines the amount of information captured through them and may vary from a “minimal dataset” collected in emergency departments (ED) to a “comprehensive dataset” with information from pre-hospital care to rehabilitation While maintaining TR is a requirement of many trauma systems, standardization of variables is important to ensure outcome comparison in terms of patient and injury characteristic. Trauma registries are well established in many high-income countries (HIC) such as the United States; have been used to promote injury prevention, change policies and to evaluate trauma system effectiveness. In many instances, the registries are guided through the American College of Surgeons guidelines for selection of data points.
As ninety percent of trauma- and injury-related deaths and disabilities occur in low-and-middle-income countries (LMICs) a significant number of these deaths can be averted through improvement in trauma care in these countries However, because information on injuries and trauma from LMICs is most often based on routine health surveys, surveillance reports, police data, and hospital-based case series, information about the process and quality of trauma care or clinical outcomes is lacking. Limited useful information on trauma care in LMICs underscores the importance of TRs in these settings. Examples of successful implementation of trauma registries in LMICs are also uncommon due to the cost of obtaining and maintaining a TR .
Aim of the study
The aim of this work was to review the present emergency records for completeness of data in the year 2016 (January first till August 31).
Secondary objectives, to give an overview of the epidemiology of the trauma cases admitted to Beni-Suef University hospital in this period, to calculate RTS, MGAP score and GAP score for all cases when sufficient data is available and compare the correlation between each score and the in-hospital mortality and finally to explore the views and opinions of physicians in the Trauma registries.
Subjects and Methods
This study is a mixed quantitative and qualitative study. For the quantitative part a retrospective analysis for all trauma medical records was conducted for all traumatized patients who admitted to the Beni-Suef university hospital over 8 months between January first and August 31.
All trauma records were reviewed to identify trauma patients who met the criteria for the trauma registry. Inclusion criteria included the following: 1) inpatient trauma admission for greater than 24 hours, 2) transferred trauma patients, 3) trauma deaths, 4) trauma activations/trauma consults (or those patients that should have been activated or consulted), 5) all traumatic brain injury patients, 6) all spinal cord injury patients, 7) all drownings/ near drownings and 8) burns. Data extraction was performed manually for each case record.
For the qualitative part an in-depth interview was conducted with a purposive sample of physicians to explore their views regarding the current trauma system, barriers and methods of improvement. All interviews were transcribed and analysed using thematic analysis.
This study revealed the following:
The results unveiled significant deficiencies in all domains of trauma records. For example, most of the records (86.5%) had <50% of trauma incident-related details. Only a third of the records had > 75% of the required administrative details and a half of the records had >75% of patients’ demographic details
Gender was recognized from the name of the patients in 530 (98.3%) case. The gender itself as a separate item was not registered at any record. The address (street and house number) was recognized in only 1.85 % of cases while the area of residence whether urban or rural was recognized in 527 (97.8%) of cases. Phone number or contact information was available in only 235(43.6%). Patients occupation for all 380 patient whom age is more than 18 years was recorded in only 70 (18.4%) of records.
The date of arrival to the hospital was recorded in 533 (98.9%), time of arrival was present in 139 record (25.8%), date of discharge was recorded in 538 (99.8%), status at discharge was recorded in 532 (98.7%) of the cases. The hospital ID number present in 479 (88.9%) of the records and the name of the physician who admits the case was present in 442 (82.0%) of the cases. Out of the total surveyed records, 282 case required activation of the trauma team, the time of activation of the trauma team was recorded in 0% of these cases, and the time of arrival of the trauma team was recorded in 18 (6.4%).
Systolic blood pressure was recognized in 423 (78.5%), pulse 364 (67.5%), respiratory rate 382 (70.9%), SPO2 41 (7.6%), Temperature 119 (22.1%), and Glasgow coma scale in (83.7%).
The mechanism of injury which was absent on (475) 84.8% of records, activity while injury occurring which was recorded on only in 117 (21.7%) record, and site of injury was recorded in only 123 (22.8%) of the records
road traffic accidents represented the largest percentage of injuries 196 (42.6%), followed by fall from height 117 (25.45), and head trauma by struck object 74 (16.1%). Road traffic accidents represented the largest percentage of injuries 196 (42.6%), followed by fall from height 117 (25.45), and head trauma by struck object 74 (16.1%).
Blunt trauma was the main type of injury (89.2%), while the largest percentage of death was due to the three reported cases of severe degree burn (100%) followed by penetrating trauma 14 (23.7%).
Regarding trauma scores, the surface area under the curve (AUC) values for the mortality was 0.881, 0.890, 0.890 for the RTS, GAP, MGAP respectively and P value was (0.000).
Regarding opinions of physicians in the current registry, participants agreed that training in how to register patient data before being involved in any health care position that requires registration of medical data is very important, the current form used to register data about injured should be updated to encounter other data elements that are very important in the management of the injured patient, missing data and lack of filling of data in accurate manner are a real concern in the current registry system. Regarding barriers against development of a strong well-functioning system, participants highlighted that lack of resources, lack of adequate number of medical staffs, lack of medical equipment and high patient volume as barriers against the development of a strong registry system. Study highlighted the need for urgent development of a digital trauma registry and learning experiences form other similar settings who succeeded to develop an affordable registry. The registry should have a clear purpose and the data revealed should be utilized in academic and quality improvement purposes.