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  • 1
    Language: English
    In: World Journal of Surgery, 2012, Vol.36(8), pp.1978-1992
    Description: Byline: Henry Thomas Stelfox (1), Manjul Joshipura (2), Witaya Chadbunchachai (3), Ranjith N. Ellawala (4), Gerard O'Reilly (5), Thai Son Nguyen (6), Russell L. Gruen (7) Abstract: Background Quality Improvement (QI) programs have been shown to be a valuable tool to strengthen care of severely injured patients, but little is known about them in low and middle income countries (LMIC). We sought to explore opportunities to improve trauma QI activities in LMIC, focusing on the Asia--Pacific region. Methods We performed a mixed methods research study using both inductive thematic analysis of a meeting convened at the Royal Australasian College of Surgeons, Melbourne, Australia, November 21--22, 2010 and a pre-meeting survey to explore experiences with trauma QI activities in LMIC. Purposive sampling was employed to invite participants with demonstrated leadership in trauma care to provide diverse representation of organizations and countries within Asia--Pacific. Results A total of 22 experts participated in the meeting and reported that trauma QI activities varied between countries and organizations: morbidity and mortality conferences (56 %), monitoring complications (31 %), preventable death studies (25 %), audit filters (19 %), and statistical methods for analyzing morbidity and mortality (6 %). Participants identified QI gaps to include paucity of reliable/valid injury data, lack of integrated trauma QI activities, absence of standards of care, lack of training in QI methods, and varying cultures of quality and safety. The group highlighted barriers to QI: limited engagement of leaders, organizational diversity, limited resources, heavy clinical workload, and medico-legal concerns. Participants proposed establishing the Asia--Pacific Trauma Quality Improvement Network (APTQIN) as a tool to facilitate training and dissemination of QI methods, injury data management, development of pilot QI projects, and advocacy for quality trauma care. Conclusions Our study provides the first description of trauma QI practices, gaps in existing practices, and barriers to QI in LMIC of the Asia--Pacific region. In this study we identified opportunities for addressing these challenges, and that work will be supported by APTQIN. Author Affiliation: (1) Department of Critical Care Medicine, Medicine and Community Health Sciences, Institute for Public Health, University of Calgary, Teaching Research & Wellness Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada (2) Academy of Traumatology, Ahmedabad, India (3) Khon Kaen Hospital, Khon Kaen, Thailand (4) College of Surgeons, Colombo, Sri Lanka (5) Emergency and Trauma Centre, The Alfred Hospital, Monash University, Melbourne, Australia (6) Duc Giang Hospital, Hanoi, Vietnam (7) The National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Australia Article History: Registration Date: 23/03/2012 Online Date: 13/04/2012
    Keywords: Information Management -- Analysis ; Information Management -- Methods ; Information Management -- Health Aspects ; Universities And Colleges -- Analysis ; Universities And Colleges -- Methods ; Universities And Colleges -- Health Aspects ; Safety Regulations -- Analysis ; Safety Regulations -- Methods ; Safety Regulations -- Health Aspects ; Medical Societies -- Analysis ; Medical Societies -- Methods ; Medical Societies -- Health Aspects ; Public Health -- Analysis ; Public Health -- Methods ; Public Health -- Health Aspects ; Quality Control -- Analysis ; Quality Control -- Methods ; Quality Control -- Health Aspects;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 2
    Language: English
    In: World Journal of Surgery, 2009, Vol.33(8), pp.1554-1561
    Description: Byline: Russell L. Gruen (1) Abstract: Introduction Saltwater crocodiles are formidable predators in northern Australia, and crocodile attacks on humans are not rare. With recent deaths highlighting this as a public health issue, an evidence-based discourse about effective methods of minimizing the danger to humans is needed. Methods Using the Haddon Matrix for injury prevention, approaches to minimizing crocodile associated death and injury were sought. Results Possibilities for harm minimization before, during and after a crocodile attack are identified, and their merits appriased. The importance of excellent prehospital and surgical and critical care is emphasized. Conclusions A combination of behavior adaptation, mutual respect, and minimizing contact will be the key to minimizing the harm from attacks, and excellent medical and surgical care will always be necessary for those unfortunate to be victims but fortunate to survive. Author Affiliation: (1) National Trauma Research Institute, Alfred Hospital, Monash University, Level 4, 89 Commercial Road, Melbourne, VIC, 3004, Australia Article History: Registration Date: 18/05/2009 Online Date: 20/06/2009
    Keywords: Crocodiles -- Health Aspects ; Public Health -- Health Aspects;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 3
    Language: English
    In: World Journal of Surgery, 2015, Vol.39(4), pp.842-853
    Description: Byline: Prasit Wuthisuthimethawee (1), Samuel J. Lindquist (2), Nicola Sandler (3), Ornella Clavisi (4), Stephanie Korin (6), David Watters (5,6), Russell L. Gruen (2,4) Abstract: Background Few guidelines exist for the initial management of wounds in disaster settings. As wounds sustained are often contaminated, there is a high risk of further complications from infection, both local and systemic. Healthcare workers with little to no surgical training often provide early wound care, and where resources and facilities are also often limited, and clear appropriate guidance is needed for early wound management. Methods We undertook a systematic review focusing on the nature of wounds in disaster situations, and the outcomes of wound management in recent disasters. We then presented the findings to an international consensus panel with a view to formulating a guideline for the initial management of wounds by first responders and subsequent healthcare personnel as they deploy. Results We included 62 studies in the review that described wound care challenges in a diverse range of disasters, and reported high rates of wound infection with multiple causative organisms. The panel defined a guideline in which the emphasis is on not closing wounds primarily but rather directing efforts toward cleaning, debridement, and dressing wounds in preparation for delayed primary closure, or further exploration and management by skilled surgeons. Conclusion Good wound care in disaster settings, as outlined in this article, can be achieved with relatively simple measures, and have important mortality and morbidity benefits. Author Affiliation: (1) Department of Emergency Medicine, Songklanagarind Hospital, Prince of Songkla University, Hatyai, Songkhla, Thailand (2) The Alfred Trauma Service, Melbourne, VIC, Australia (3) Royal Perth Hospital, Perth, WA, Australia (4) National Trauma Research Institute, The Alfred Hospital, Monash University, Level 4, 89 Commercial Road, Melbourne, VIC, 3004, Australia (5) Department of Surgery, Barwon Health Geelong, Barwon Health and Deakin University, Geelong, VIC, Australia (6) Royal Australasian College of Surgeons, Melbourne, VIC, Australia Article History: Registration Date: 04/06/2014 Online Date: 02/08/2014
    Keywords: Medical Personnel – Health Aspects ; Wound Care – Health Aspects ; Emergency Medicine – Health Aspects;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 4
    Language: English
    In: World Journal of Surgery, 2016, Vol.40(11), pp.2611-2619
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00268-016-3614-y Byline: Kathleen M. O'Neill (1,2), Sarah L. M. Greenberg (1,3), Meena Cherian (4), Rowan D. Gillies (5), Kimberly M. Daniels (1,6), Nobhojit Roy (7,8), Nakul P. Raykar (1,9), Johanna N. Riesel (1,10), David Spiegel (11), David A. Watters (12,13), Russell L. Gruen (14,15) Abstract: Background Surgical conditions represent a significant proportion of the global burden of disease, and therefore, surgery is an essential component of health systems. Achieving universal health coverage requires effective monitoring of access to surgery. However, there is no widely accepted standard for the required capabilities of a first-level hospital. We aimed to determine whether a group of operations could be used to describe the delivery of essential surgical care. Methods We convened an expert panel to identify procedures that might indicate the presence of resources needed to treat an appropriate range of surgical conditions at first-level hospitals. Using data from the World Health Organization Emergency and Essential Surgical Care Global database, collected using the WHO Situational Analysis Tool (SAT), we analysed whether the ability to perform each of these procedures--which we term "bellwether procedures"--was associated with performing a full range of essential surgical procedures. Findings The ability to perform caesarean delivery, laparotomy, and treatment of open fracture was closely associated with performing all obstetric, general, basic, emergency, and orthopaedic procedures (p 〈 0.001) in the population that responded to the WHO SAT Survey. Procedures including cleft lip, cataract, and neonatal surgery did not correlate with performing the bellwether procedures. Interpretation Caesarean delivery, laparotomy, and treatment of open fractures should be standard procedures performed at first-level hospitals. With further validation in other populations, local managers and health ministries may find this useful as a benchmark for what first-level hospitals can and should be able to perform on a 24/7 basis in order to ensure delivery of emergency and essential surgical care to their population. Those procedures which did not correlate with the bellwether procedures can be referred to a specialized centre or collected for treatment by a visiting specialist team. Author Affiliation: (1) Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA (2) Department of Surgery, Yale New Haven Hospital, 1245 Chapel Street Apt 503, New Haven, CT, 06510, USA (3) Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA (4) WHO Emergency and Essential Surgical Care Programme, The World Health Organization, Headquarters, Geneva, Switzerland (5) Royal North Shore Hospital, Plastic, Reconstructive and Burns, Reserve Rd, St Leonards, NSW, 2065, Australia (6) Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA (7) Department of Surgery, Bhabha Atomic Research Center (BARC) Hospital, Mumbai, 94, India (8) Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (9) Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA (10) The Harvard Program in Plastic Surgery, Boston, MA, 02114, USA (11) Department of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA (12) Royal Australasian College of Surgeons, East Melbourne, VIC, Australia (13) School of Medicine, Faculty of Health, Barwon Health, Deakin University, Geelong, VIC, Australia (14) The Alfred Hospital and Monash University, Melbourne, VIC, 3051, Australia (15) Nanyang Technological University, 50 Nanyang Drive, Research Techno Plaza, Level 4 X-Frontiers Block, Singapore, 637553, Singapore Article History: Registration Date: 11/06/2016 Online Date: 28/06/2016 Article note: Disclaimer: The authors include WHO staff. The views expressed in this publication reflect their views and not necessarily that of WHO.
    Keywords: Delivery (Childbirth) -- Analysis ; Laparotomy -- Analysis;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 5
    Language: English
    In: World Journal of Surgery, 2015, Vol.39(4), pp.856-864
    Description: Byline: David A. Watters (1), Michael J. Hollands (2), Russell L. Gruen (3), Kiki Maoate (4), Haydn Perndt (5), Robert J. McDougall (6), Wayne W. Morriss (7), Viliami Tangi (8), Kathleen M. Casey (9), Kelly A. McQueen (10) Abstract: Introduction The unmet global burden of surgical disease is substantial. Currently, two billion people do not have access to emergency and essential surgical care. This results in unnecessary deaths from injury, infection, complications of pregnancy, and abdominal emergencies. Inadequately treated surgical disease results in disability, and many children suffer deformity without corrective surgery. Methods A consensus meeting was held between representatives of Surgical and Anaesthetic Colleges and Societies to obtain agreement about which indicators were the most appropriate and credible. The literature and state of national reporting of perioperative mortality rates was reviewed by the authors. Results There is a need for a credible national and/or regional indicator that is relevant to emergency and essential surgical care. We recommend introducing the perioperative mortality rate (POMR) as an indicator of access to and safety of surgery and anaesthesia. POMR should be measured at two time periods: death on the day of surgery and death before discharge from hospital or within 30 days of the procedure, whichever is sooner. The rate should be expressed as the number of deaths (numerator) over the number of procedures (denominator). The option of before-discharge or 30 days is practical for those low- to middle-income countries where postdischarge follow-up is likely to be incomplete, but it allows those that currently can report 30-day mortality rates to continue to do so. Clinical interpretation of POMR at a hospital or health service level will be facilitated by risk stratification using age, urgency (elective and emergency), procedure/procedure group, and the American Society of Anesthesiologists grade. Conclusions POMR should be reported as a health indicator by all countries and regions of the world. POMR reporting is feasible, credible, achieves a consensus of acceptance for reporting at national level. Hospital and Service level POMR requires interpretation using simple measures of risk adjustment such as urgency, age, the condition being treated or the procedure being performed and ASA status. Author Affiliation: (1) Deakin University and Barwon Health, Royal Australasian College of Surgeons, 1 Spring Street, Melbourne, VIC, 3000, Australia (2) Royal Australasian College of Surgeons, 1 Spring Street, Melbourne, VIC, 3000, Australia (3) Royal Australasian College of Surgeons, National Trauma Research Institute, Level 4, 89 Commercial Road, Melbourne, VIC, Australia (4) Children's Specialist Centre, 58 Colombo Street, Cashmere, Christchurch, New Zealand (5) School of Medicine, Royal Hobart Hospital, The University of Tasmania, GPO Box 1061 L, Hobart, TAS, Australia (6) The Royal Children's Hospital Melbourne, Flemington Road, Parkville, Melbourne, VIC, Australia (7) Christchurch Hospital, Riccarton Avenue, Addington, Christchurch, New Zealand (8) Ministry of Health, Taufa'ahau Road, Nuku'alofa, Tonga (9) American College of Surgeons, 633 N. Saint Clair Street, Chicago, IL, USA (10) Vanderbilt University Medical Centre, 1211 Medical Centre Drive, Nashville, TN, USA Article History: Registration Date: 01/05/2014 Online Date: 20/05/2014
    Keywords: Surgery – Health Aspects ; Anesthesia – Health Aspects;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 6
    Language: English
    In: World Journal of Surgery, April, 2017, Vol.41(4), p.954(9)
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00268-016-3759-8 Byline: Angela Lashoher (1), Eric B. Schneider (2,3), Catherine Juillard (4), Kent Stevens (5), Elizabeth Colantuoni (6), William R. Berry (7), Christina Bloem (8), Witaya Chadbunchachai (9), Satish Dharap (10), Sydney M. Dy (11), Gerald Dziekan (12), Russell L. Gruen (13), Jaymie A. Henry (14), Christina Huwer (15), Manjul Joshipura (16), Edward Kelley (17), Etienne Krug (18), Vineet Kumar (19), Patrick Kyamanywa (20), Alain Chichom Mefire (21), Marcos Musafir (22), Avery B. Nathens (23), Edouard Ngendahayo (24), Thai Son Nguyen (25), Nobhojit Roy (26), Peter J. Pronovost (27), Irum Qumar Khan (28), Junaid Abdul Razzak (29,30), Andres M. Rubiano (31), James A. Turner (32), Mathew Varghese (33), Rimma Zakirova (34), Charles Mock (35) Abstract: Background Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured patients in low-, middle-, and high-income countries. Methods From 2010 to 2012, the impact of the World Health Organization (WHO) Trauma Care Checklist program was assessed in 11 hospitals using a stepped wedge pre- and post-intervention comparison with randomly assigned intervention start dates. Study sites represented nine countries with diverse economic and geographic contexts. Primary end points were adherence to process of care measures secondary data on morbidity and mortality were also collected. Multilevel logistic regression models examined differences in measures pre- versus post-intervention, accounting for patient age, gender, injury severity, and center-specific variability. Results Data were collected on 1641 patients before and 1781 after program implementation. Patient age (mean 34 [+ or -] 18 vs. 34 [+ or -] 18), sex (21 vs. 22 % female), and the proportion of patients with injury severity scores (ISS) a[yen] 25 (10 vs. 10 %) were similar before and after checklist implementation (p 〉 0.05). Improvement was found for 18 of 19 process measures, including greater odds of having abdominal examination (OR 3.26), chest auscultation (OR 2.68), and distal pulse examination (OR 2.33) (all p 〈 0.05). These changes were robust to several sensitivity analyses. Conclusions Implementation of the WHO Trauma Care Checklist was associated with substantial improvements in patient care process measures among a cohort of patients in diverse settings. Author Affiliation: (1) 14 Chemin de Contamine, 01420, Chanay, France (2) Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA (3) Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD, USA (4) Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Ave, 3A, San Francisco, CA, 94110, USA (5) The Johns Hopkins School of Medicine, 1800 Orleans Street, Suite 6107E, Baltimore, MD, 21287, USA (6) Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, Baltimore, MD, 21205, USA (7) Department of Health Policy and Management, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA (8) Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1228, Brooklyn, NY, 11203, USA (9) WHO Collaborating Center for Injury Prevention and Safety Promotion, Khon Kaen Hospital, Khon Kaen, 40000, Thailand (10) Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India (11) Johns Hopkins Bloomberg School of Public Health, Rm 609, 624 N Broadway, Baltimore, MD, 21205, USA (12) World Self-Medication Industry, Rue de Cossonay 5, Case Postale 124, 1023, Crissier, Switzerland (13) Lee Kong Chian School of Medicine, Nanyang Technological University, Research Techno Plaza, 02-07, 50 Nanyang Drive, Singapore, 637553, Singapore (14) Department of Surgery, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA (15) Clinic for Trauma Surgery and Orthopedics, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany (16) Academy of Traumatology, 504, Sangita Complex, Parimal Garden, Ahmadabad, 380015, India (17) Service Delivery and Safety Department, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland (18) Department for the Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland (19) Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, College Building, First Floor, Sion, Mumbai, 400022, India (20) School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Nyarugenge Campus, P.O. Box. 3286, Kigali, Rwanda (21) Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, P.O. Box 25526, Yaounde, Cameroon (22) Federal University of Rio de Janeiro, Rua Voluntarios da Patria, 445 SL 201, Botafogo, Rio de Janeiro, CEP: 22270-005, Brazil (23) Department of Surgery, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D5 74, Toronto, Ontario, M4N 3M5, Canada (24) University Teaching Hospital of Kigali, P.O. Box 2534, Kigali, Rwanda (25) Duc Giang General Hospital, 54 Truong Lam, Long Bien, Hanoi, Vietnam (26) Department of Surgery, BARC hospital (Govt of India), HBNI University, Anushaktinagar, Mumbai, 400094, India (27) Johns Hopkins Medicine, 600 N Wolfe Street, CMSC 131, Baltimore, MD, 21287, USA (28) Department of Emergency Medicine, Aga Khan University, 1st floor, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan (29) Johns Hopkins University School of Medicine, 5801 Smith Ave, Ste 220, Baltimore, MD, 21219, USA (30) Aga Khan University, Karachi, Pakistan (31) MEDITECH Foundation, Neiva University Hospital, Calle 5 11-19, Huila, Neiva, Colombia (32) Department of Paedeatric Orthopedics, Sick Kids Hospital, 555 University Ave, Toronto, ON, M5G 1X8, Canada (33) Department of Orthopaedics, St Stephen's Hospital, Tis Hazari, Delhi, 110054, India (34) St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada (35) Department of Surgery, Harborview Medical Center, HIPRC, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA Article History: Registration Date: 04/10/2016 Online Date: 31/10/2016
    Keywords: Public Health -- Economic Aspects
    ISSN: 0364-2313
    E-ISSN: 14322323
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  • 7
    Language: English
    In: World journal of surgery, April 2017, Vol.41(4), pp.954-962
    Description: Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured patients in low-, middle-, and high-income countries. From 2010 to 2012, the impact of the World Health Organization (WHO) Trauma Care Checklist program was assessed in 11 hospitals using a stepped wedge pre- and post-intervention comparison with randomly assigned intervention start dates. Study sites represented nine countries with diverse economic and geographic contexts. Primary end points were adherence to process of care measures; secondary data on morbidity and mortality were also collected. Multilevel logistic regression models examined differences in measures pre- versus post-intervention, accounting for patient age, gender, injury severity, and center-specific variability. Data were collected on 1641 patients before and 1781 after program implementation. Patient age (mean 34 ± 18 vs. 34 ± 18), sex (21 vs. 22 % female), and the proportion of patients with injury severity scores (ISS) ≥ 25 (10 vs. 10 %) were similar before and after checklist implementation (p 〉 0.05). Improvement was found for 18 of 19 process measures, including greater odds of having abdominal examination (OR 3.26), chest auscultation (OR 2.68), and distal pulse examination (OR 2.33) (all p 〈 0.05). These changes were robust to several sensitivity analyses. Implementation of the WHO Trauma Care Checklist was associated with substantial improvements in patient care process measures among a cohort of patients in diverse settings.
    Keywords: Checklist ; Process Assessment (Health Care) -- Standards ; Wounds and Injuries -- Therapy
    E-ISSN: 1432-2323
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 8
    Language: English
    In: World journal of surgery, October 2019, Vol.43(10), pp.2426-2437
    Description: The completeness of a trauma registry's data is essential for its valid use. This study aimed to evaluate the extent of missing data in a new multicentre trauma registry in India and to assess the association between data completeness and potential predictors of missing data, particularly mortality. The proportion of missing data for variables among all adults was determined from data collected from 19 April 2016 to 30 April 2017. In-hospital physiological data were defined as missing if any of initial systolic blood pressure, heart rate, respiratory rate, or Glasgow Coma Scale were missing. Univariable... Data on the 4466 trauma patients in the registry were analysed. Out of 59 variables, most (n = 51; 86.4%) were missing less than 20% of observations. There were 808 (18.1%) patients missing at least one of the first in-hospital physiological observations. Hospital death was associated with missing in-hospital... Most variables were well collected. Hospital death, a proxy for more severe injury, was associated with missing first in-hospital physiological observations. This remains an important limitation for trauma registries.
    Keywords: Heart Rate -- Analysis;
    ISSN: 03642313
    E-ISSN: 1432-2323
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