Severely injured trauma patients and trauma deaths due to severe injury are a burden to the world as these patients are often young, treatment is costly, and outcomes can be unsatisfactory. Trauma registries around the world collect valuable information about these patients, injury mechanisms, sustained injuries, treatment methods, and outcomes. With this information, research can be performed to better understand how to prevent these injuries and how to provide better care for these patients. New treatment modalities can be tested and analyzed with the data. Trauma registry data are also used for resource allocations and administrative decision making in hospitals, hospital districts, and nationally within countries. International comparisons and collaborations are also possible with this data. Therefore, the data must be valid; it must be reliable, complete, and correct. Otherwise, the conclusions made with the data can be misleading or even completely wrong. The Helsinki Trauma Registry (HTR) is a local trauma registry of the Helsinki University Hospital Trauma Unit. Since 2006, data of severely injured patients has been recorded to the registry. Thus far, there are more than 5000 patients in the registry. This study focused on evaluating the quality of the HTR by assessing the case completeness, data completeness, data accuracy, and data correctness. We compared the HTR data to patient files and Finnish Hospital Discharge Registry (FHDR) data. We also compared a patient group with severe chest injury to a similar group of patients from the German trauma registry (TR-DGU) to verify the comparability of the HTR data with international data and to identify possible differences in treatment, outcomes, and resource use with these patients. This was also an external validation of the HTR. Finally, we used the HTR data on road traffic injury patients as a reference to test the accuracy and reliability of an international, EU-recommended, ICD-AIS mapping tool in Finnish patient material. This tool generates injury severity classification scores from commonly used ICD-10 injury diagnosis codes automatically instead of the AIS (Abbreviated Injury Scale) coding performed by an expert coder. We discovered that the HTR yields quality data of seriously injured patients. Case completeness (97%), data completeness (93-99%), data accuracy (90-95%), and data correctness (97%) were excellent and therefore can reliably be used for research, administrative decision making, and national or international comparisons. Comparisons with the TR-DGU could be performed without problems. The treatment results (main outcome was survival) of patients with severe chest injury were similar in Finland and Germany; however, this was managed in Finland with fewer resources. We observed that the ICD-AIS mapping tool is not reliable in Finnish patient material. In the future, we should establish a high-class nationwide Finnish trauma registry that includes the trauma units of the five Finnish University Hospitals and the largest Central Hospitals that treat multiple severely injured trauma patients per year. In this way, we could more effectively unify treatment protocols, learn from each trauma unit, and improve the already good treatment of severely injured trauma patients in Finland. As treating severely injured patients is costly and resource consuming, we must also know the treatment results to ensure that our work among trauma patients is cost effective. This way we can ensure that limited health care resources are prioritized correctly. This is only possible with an effective nationwide Finnish trauma registry.
|Julkaistu - 2020
|G5 Tohtorinväitöskirja (artikkeli)
LisätietojaM1 - 105 s. + liitteet
- 3126 Kirurgia, anestesiologia, tehohoito, radiologia