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Comment & Response
December 4, 2019

Inclusion of All Patients Admitted for Trauma in Trauma Registries—Reply

Author Affiliations
  • 1Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland
  • 2Department of Surgery, University of Washington, Seattle
JAMA Surg. 2020;155(3):265-266. doi:10.1001/jamasurg.2019.4941

In Reply We thank Van der Vliet et al for their insightful comments. Regarding data in US trauma systems, there is room to learn from the Dutch example and others who have taken a more inclusive approach to trauma registries. We also agree with their assertion that trauma registries should include all patients admitted for trauma because we have previously shown the utility of this broader inclusion criterion for US trauma registries.1 Compared with standardized US trauma registry inclusion,2 capturing all admitted patients regardless of hospital missed fewer postinjury deaths (23.3% vs 62.1%), seriously injured patients (10.5% vs 39.2%), and patients requiring early critical resources (13.1% vs 23.8%).1 However, such a suggestion is counterbalanced by the resources, logistics, and funding required to operationalize these changes. As we mention in our article,3 it is time to consider full-scale changes to US trauma registries that move away from labor-intensive and relatively inefficient processes, such as medical record abstraction, to more automated techniques based on electronic health record data, natural language-processing software, health information exchanges, and other existing data platforms that span multiple hospitals and health systems. Some manual extraction may still be required to ensure high data quality, but we live in an increasingly electronic data–heavy world that could be leveraged to further optimize our ability to track, study, and optimize care for injured patients.

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