How Translators Affect the Experience and Healthcare of Primary Spanish-Speaking Patients in the Trauma Department

Background and Objective: The trauma bay is a fast-paced environment where comprehension of medical jargon is difficult even for native English-speaking patients. For Spanish-speaking patients, the presence, and use of the translating tools in hospitals may change the course and/or quality of their care, especially in a trauma setting. Our objective was to gather information and perspectives of Spanish-speaking patients in the trauma bay and subsequent hospitalization. This pilot study determined if there were constant themes. Methods: In this pilot qualitative study, we successfully recruited three adult primary Spanish-speaking patients admitted to the trauma service for at least twenty-four hours in July 2021 at an urban academic level I trauma center. Spanish only in-person semi-structured interviews were used to gather patient’s perspectives, with data supplemented from electronic health records and trauma registries. The interview was transcribed in Spanish, translated to English, coded, and analyzed using thematic analysis. Results: Although recruitment occurred at both hospitals, this study includes only three patients admitted at IU Health Methodist. All three were males aged 22-37 years from Latin America. Blunt injuries occurred in two with injury severity scores (ISS) ranging from 5-11 while the third had penetrating injuries with an ISS of 10. Several themes have emerged. All patients felt they did not have autonomy or empowerment in their care. It was found that the healthcare team decided who received a translator. Two of the patients had a lack of understanding in their traumatic injuries. One patient relied on his partner for translating, even though a translator was provided. Conclusions: These results suggest that Spanish-speaking trauma patients lack autonomy, empowerment, and understanding their medical conditions. Further interviews need to be conducted in order to strengthen the perspective of a Spanish-speaking trauma patient’s care.

Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries

Background: Injury is a major global health problem, causing >5,800,000 deaths annually and widespread disability largely attributable to neurotrauma. 89% of trauma deaths occur in low- and middle-income countries (LMICs), however data on neurotrauma epidemiology in LMICs is lacking. In order to support neurotrauma surveillance efforts, we present a review and analysis of data dictionaries from national registries in LMICs. Methods: We performed a scoping review to identify existing national trauma registries for all LMICs. Inclusion/exclusion criteria included articles published since 1991 describing national registry neurotrauma data capture methods in LMICs. Data sources included PubMed and Google Scholar using the terms "trauma/neurotrauma registry" and country name. Resulting registries were analyzed for neurotrauma-specific data dictionaries. These findings were augmented by data from direct contact of neurotrauma organizations, health ministries, and key informants from a convenience sample. These data were then compared to the WHO minimum dataset for injury (MDI) from the international registry for trauma and emergency care. Results: We identified 15 LMICs with 16 total national trauma registries tracking neurotrauma-specific data elements. Among these, Cameroon had the highest concordance with the MDI, followed by Colombia, Iran, Myanmar and Thailand. The MDI elements least often found in the data dictionaries included helmet use, and alcohol level. Data dictionaries differed significantly among LMICs. Common elements included Glasgow Coma Score, mechanism of injury, anatomical site of injury and injury severity scores. Limitations included low response rate in direct contact methods. Conclusion: Significant heterogeneity was observed between the neurotrauma data dictionaries, as well as a spectrum of concordance or discordance with the MDI. Findings offer a contextually relevant menu of possible neurotrauma data elements that LMICs can consider tracking nationally to enhance neurotrauma surveillance and care systems. Standardization of nationwide neurotrauma data collection can facilitate international comparisons and bidirectional learning among health care governments.

Utility of an orthopaedic trauma registry in Ghana

In most low- and middle-income countries, trauma registries are uncommon. Although institutional registries for all trauma patients are ideal, it can be more practical to institute departmental registries for specific subsets of patients. Komfo Anokye Teaching Hospital (KATH) has started a locally developed, self-funded orthopaedic trauma registry. We describe methods and experiences for data collection and examine patient and injury characteristics, data quality, and the utility of the registry. Of 961 individuals in the registry, 67.9% were males, and the median age was 40 years. Motor vehicle collision (23.3%) was the most frequent mechanism of injury. Lower extremity fractures were the most common injury (60.6%), and 43.9% of injuries were managed operatively. Data quality was reasonable with missingness under 10% for 13 of 14 key variables, with inconsistencies of dates of injury, admission, treatment, and discharge in 9.1% of cases. However, the type of operation was missing for 73.2% of operative cases. Despite these limitations, the registry has been used for quality improvement and to successfully advocate for resources to improve trauma care. The registry has been improved by adding more detailed outcome variables, creating a standardisedcodebook of categorical variables, and adding more fields to allow for multiple injuries. In conclusion, it is practical and sustainable to institute a locally developed, self-funded orthopaedic trauma registry in Ghana that provides data with reasonable quality. Such a registry can be used to advocate for more resources to care for injured patients adequately and for quality improvement.

Accuracy of injury coding in a trauma registry

Introduction Abbreviated Injury Scale has significant advantages over administrative coding systems for trauma analytics as it was developed specifically for injury, provides greater depth of characterisation of injury and has an integrated severity measure. It is used by trauma registries globally as it allows benchmarking between registries and is used to drive quality improvement. However, the consistency of scoring between individuals is not well understood. An audit was undertaken in six tertiary trauma centres in New Zealand to determine variation between AIS coders. Methods Each of six sites was audited by two experienced auditors. A random selection of case was identified in ISS categories 13–24, 25–44 and 45+. The case notes were pulled, and the auditors independently audited the notes,and then compared their results for a consensus result. The consensus result was then compared with the original coders. Results 111 cases were audited. Coding concordance was found in 31% of cases. Of the 69% of cases where discordant coding was observed, the discordance was attributed to incorrect coding (49%), missed injuries (43%) and other reasons (7%). Head and chest body regions were associated with the greatest number, and largest differences in coding scores. The overall mean difference across all cases was an ISS score of 1. Conclusions The overall accuracy of data held in the New Zealand Trauma Registry (NZTR) is suitable for quality improvement and benchmarking purposes, but more work is needed to improve the accuracy of individual cases, particularly those with head/neck and chest injury. Standardised tools to ensure the accuracy of data in a trauma registry is a gap which needs to be addressed to maintain confidence in a contemporary trauma system.

Review of Military Casualties in Modern Conflicts—The Re-emergence of Casualties From Armored Warfare

ABSTRACT Introduction The re-emergence of armored warfare in modern conflicts has resulted in a higher number of extremity injuries, burns, and brain injuries. Despite this dramatic increase, little is reported on the type of injuries caused and their management. This review summarizes the publicly available literature and reports on the rate and type of injuries related to armored warfare, their medical outcomes, and management limitations. Materials and Methods This rapid evidence review involves a systematic literature search, followed by a non-systematic literature review. The reason for choosing this approach was the inherent lack of quantitative outcome data in the literature to satisfy the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study also used content analysis to study all peer-reviewed articles, focusing on similarities and differences in the findings necessary to formulate tentative results. The electronic search included PubMed, Scopus, and Web of Science, using the following search string: “Armored; Injuries; Mechanized; Morbidity; Mortality; War; Warfare”, alone or in combination. Results Modern conflicts are associated with higher number of extremity injuries, burns, and brain injuries among military casualties. Several publications claim that the characteristics of armored warfare and anticipated injuries in this type of warfare might require the far forward deployment of medical support supported by a reliable casualty evacuation chain. Still the quality of the available casualty data is low. Conclusions Because of the limited availability of reliable data or military trauma registries, up-to-date military casualty estimation remains a recognized knowledge gap, which needs to be addressed by armed forces worldwide. The future management of modern war casualties requires professional and well-trained staff in all levels, indicating a need for educational initiatives to provide both nurses and medics a greater proportion of medical care and management capabilities and responsibilities than in past conflicts.

Systematic review of the epidemiology of a single physical trauma and cancer

Background A systematic review of single physical trauma and cancer was carried out, with a meta-analysis where deemed appropriate. Methods A comprehensive search of the literature including databases such as Medline and Embase identified 1529 potentially relevant papers for inclusion. A further 89 potentially relevant studies were identified from bibliographies. After review of titles and abstracts and then full papers, a total of 77 studies were included in the broader review of trauma and cancer, and 31 of these studies considered single physical trauma and cancer. The searches were carried out in June 2016. Results Although physical trauma as a cause of cancer has been an issue of clinical interest for decades, the epidemiological evidence was sparse. Only for traumatic brain injury and brain cancer was there considered a sufficient number of epidemiological studies for a meta-analysis. A random effects meta-relative risk for glioma from cohort studies was 0.96 (95% CI: 0.49 to 1.88) and 1.53 (95% CI: 1.02 to 2.27) for case-control studies. The equivalent results for meningioma were 1.22 (95% CI: 0.85 to 1.76) and 1.88 (95% CI: 0.84 to 1.49) respectively. Conclusions Further work is required to clarify whether physical trauma has a role in cancer development, perhaps by exploiting trauma registries.

Systematic review of the epidemiology of a single physical trauma and cancer

Background A systematic review of single physical trauma and cancer was carried out, with a meta-analysis where deemed appropriate. Methods A comprehensive search of the literature including databases such as Medline and Embase identified 1529 potentially relevant papers for inclusion. A further 89 potentially relevant studies were identified from bibliographies. After review of titles and abstracts and then full papers, a total of 77 studies were included in the broader review of trauma and cancer, and 31 of these studies considered single physical trauma and cancer. The searches were carried out in June 2016. Results Although physical trauma as a cause of cancer has been an issue of clinical interest for decades, the epidemiological evidence was sparse. Only for traumatic brain injury and brain cancer was there considered a sufficient number of epidemiological studies for a meta-analysis. A random effects meta-relative risk for glioma from cohort studies was 0.96 (95% CI: 0.49 to 1.88) and 1.53 (95% CI: 1.02 to 2.27) for case-control studies. The equivalent results for meningioma were 1.22 (95% CI: 0.85 to 1.76) and 1.88 (95% CI: 0.84 to 1.49) respectively. Conclusions Further work is required to clarify whether physical trauma has a role in cancer development, perhaps by exploiting trauma registries.