Review of military and civilian trauma registries: Does consensus matter?

Abstract

BACKGROUND: Structural collection of data from combat injuries is important to improve provided care and the outcome of (combat) casualties. Trauma registries are used in civilian and military health care systems for systematic administration of injury data. However, these registries often use different methods of data management, compromising international comparison of trauma systems. The aim of this review is to aid in reaching international (coalition-wide) consensus for compatible data collection methods with uniform definitions, which is needed for transnational research and subsequent improvement of medical support organizations. METHODS: In this descriptive review, we analyzed different data sets from trauma systems within the American-European context, and included data variables from civilian and military trauma registries. These data sets were analyzed to identify a core set of variables fundamental to describing the tactical context, epidemiology, injury mechanism, injury severity, key treatment, and outcome. RESULTS: A total of 1,672 unique variables, of which 536 military specific, were identified and divided in 11 elemental categories of medical care (patient info, incident info, injury diagnoses, prehospital care, emergency department, imaging, surgical treatment, intensive care, ward, discharge and outcome) and three military-specific categories (forward medical evacuation, prehospital medical treatment facility, and discharge out of theater). A total of 203 key variables were identified and considered fundamental for effective (military) trauma research. CONCLUSION: Well-established and reliable trauma registries and databases are fundamental in (military) trauma care. We recommend implementation of a (concurrent) UN/NATO wide registry system with a track and follow-up system to further improve the quality of care and registration of casualties. Further research should focus on real time aids available on the battlefield and direct storage/upload in trauma databases in theater. Ultimately, sound and valid data support medical decision process and evaluation necessary to save lives on the battlefield.