Association Between Real-time Electronic Injury Surveillance Applications and Clinical Documentation and Data Acquisition in a South African Trauma Center

Background: Building surgical capacity through global surgery partnerships (GSPs) between high and low- and middle-income countries (LMICs) is a rising global health focus. Our aim was to conduct a systematic review to characterize strategies employed by GSPs to build capacity and promote sustainability and to propose a novel reproducible model for sustainability. Methods: We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched PubMed, EMBASE, Medline and African Journals Online to identify all peer-reviewed articles published between 2000 and 2016 that described GSPs between partners from the United States or Canada or both and partners from LMICs. We excluded papers that described nonsurgical GSPs, unilateral GSPs (e.g., humanitarian missions) or military initiatives. Descriptive features were analyzed, with a focus on attributes that promote sustainability. We then proposed criteria for sustainability on the basis of the themes that emerged from our review. Results: Our search retrieved 3580 abstracts, which were then independently reviewed by 4 authors. A total of 128 papers (3.6%) met the inclusion criteria. They described GSPs in 68 countries on 5 continents. Among the GSPs, 21.9% demonstrated community engagement and 51.6% included multidisciplinary collaboration. Surgical training or education was provided in 81.3% of GSPs. Although 64.8% of GSPs collected data, only 53.1% reported project-related outcomes. A total of 55.5% had bilateral authorship for publications, and 28.9% had multisource funding. Only 1 GSP fulfilled all 6 of our criteria for sustainability. Conclusion: In this systematic review we identified 6 pillars that are indicators of sustainability: community engagement, multidisciplinary collaboration, education and training, outcomes reporting, bilateral authorship and multisource funding. We propose that future GSPs should build on a foundation of bilateral ideas and expertise exchange, that they should have defined and measurable objectives, that they should engage in continuous evaluation of program outcomes and that they should take a thoughtful and transparent approach to sustained capacity building.

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“…We can help build data collection infrastructure by exporting electronic registries applicable to low-resource settings. 27 , 28 …”

Section: Discussionmentioning

confidence: 99%

“…We can help build data collection infrastructure by exporting electronic registries applicable to low-resource settings. 27,28 The culmination of successful academic partnerships is coauthorship in research publications. It is disappointing that some GSPs do not result in published recognition of contributing partners.…”

Section: Bilateral Authorshipmentioning

confidence: 99%

A systematic review of global surgery partnerships and a proposed framework for sustainability

Jedrzejko

Margolick

Nguyen

et al. 2021

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“…Nonetheless, the ingredients for successful trauma registry implementation that have been well-documented in the literature, including local stakeholder buy-in, a motivated workforce, and secure funding, were crucial elements in the development, implementation, and ongoing presence of the SRRH registry. One way to address its shortcomings might be to transition away from the use of paper, as numerous studies have noted the high rates of data completeness and correctness associated with electronic trauma registries [ 30 ]. Unfortunately, their implementation is not yet feasible in a setting like rural Uganda.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of injured patients in rural Uganda: A prospective trauma registry’s first 1000 days

et al. 2021

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Trauma is a leading cause of morbidity and mortality worldwide. Data characterizing the burden of injury in rural Uganda is limited. Hospital-based trauma registries are a critical tool in illustrating injury patterns and clinical outcomes. This study aims to characterize the traumatic injuries presenting to Soroti Regional Referral Hospital (SRRH) in order to identify opportunities for quality improvement and policy development. From October 2016 to July 2019, we prospectively captured data on injured patients using a locally designed, context-relevant trauma registry instrument. Information regarding patient demographics, injury characteristics, clinical information, and treatment outcomes were recorded. Descriptive, bivariate, and multivariate statistical analyses were conducted. A total of 4109 injured patients were treated during the study period. Median age was 26 years and 63% were male. Students (33%) and peasant farmers (31%) were the most affected occupations. Falls (36%) and road traffic injuries (RTIs, 35%) were the leading causes of injury. Nearly two-thirds of RTIs were motorcycle-related and only 16% involved a pedestrian. Over half (53%) of all patients had a fracture or a sprain. Suffering a burn or a head injury were significant predictors of mortality. The number of trauma patients enrolled in the study declined by five-fold when comparing the final six months and initial six months of the study. Implementation of a context-appropriate trauma registry in a resource-constrained setting is feasible. In rural Uganda, there is a significant need for injury prevention efforts to protect vulnerable populations such as children and women from trauma on roads and in the home. Orthopedic and neurosurgical care are important targets for the strengthening of health systems. The comprehensive data provided by a trauma registry will continue to inform such efforts and provide a way to monitor their progress moving forward.

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“…In particular, the use of spatial data to identify injury hotspots within the context of the built environment has potential to be especially beneficial for informing prevention efforts. [29][30][31] For example, in rural Kenya, a health center-based injury surveillance system that incorporated GPS data was able to identify environmental correlates at the locations of injuries through geographic information systems (GIS) software and analyses. 31 Distance to major roads proved to be a major determinant of injury in this area.…”

Section: Opportunitiesmentioning

confidence: 99%

“…29 49 In one case, missing data were reduced by 25% on average from a previous paper-based charting system. 29 Data collectors have found that the apps developed for these purposes are easier and quicker to populate compared with paper-based methods, often making use of convenient drop-down menus or prompts that remind the user of a blank field. 29 49 50 Furthermore, the capability for a system administrator to view data-entry in real time has improved quality control efforts and, consequently, data compliance.…”

Section: Challengesmentioning

confidence: 99%

Maximizing the potential of trauma registries in low-income and middle-income countries

Rosenkrantz

Schuurman

Arenas

et al. 2020

Trauma Surg Acute Care Open

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Injury is a major global health issue, resulting in millions of deaths every year. For decades, trauma registries have been used in wealthier countries for injury surveillance and clinical governance, but their adoption has lagged in low-income and middle-income countries (LMICs). Paradoxically, LMICs face a disproportionately high burden of injury with few resources available to address this pandemic. Despite these resource constraints, several hospitals and regions in LMICs have managed to develop trauma registries to collect information related to the injury event, process of care, and outcome of the injured patient. While the implementation of these trauma registries is a positive step forward in addressing the injury burden in LMICs, numerous challenges still stand in the way of maximizing the potential of trauma registries to inform injury prevention, mitigation, and improve quality of trauma care. This paper outlines several of these challenges and identifies potential solutions that can be adopted to improve the functionality of trauma registries in resource-poor contexts. Increased recognition and support for trauma registry development and improvement in LMICs is critical to reducing the burden of injury in these settings.

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Association Between Real-time Electronic Injury Surveillance Applications and Clinical Documentation and Data Acquisition in a South African Trauma Center

Abstract: Accurate capture and simultaneous analysis of trauma data in low-resource trauma settings are feasible through the integration of surveillance into clinical workflow and the timely analysis of electronic data.

Cited by 21 publications

References 25 publications

A systematic review of global surgery partnerships and a proposed framework for sustainability

A systematic review of global surgery partnerships and a proposed framework for sustainability

Epidemiology of injured patients in rural Uganda: A prospective trauma registry’s first 1000 days

Maximizing the potential of trauma registries in low-income and middle-income countries

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