title: Benchmarking of trauma care worldwide: the potential value of an International Trauma Data Bank (ITDB).
abstract: BACKGROUND
  National trauma registries have helped improve patient outcomes across the world. Recently, the idea of an International Trauma Data Bank (ITDB) has been suggested to establish global comparative assessments of trauma outcomes. The objective of this study was to determine whether global trauma data could be combined to perform international outcomes benchmarking.
  
  
  METHODS
  We used observed/expected (O/E) mortality ratios to compare two trauma centers [European high-income country (HIC) and Asian lower-middle income country (LMIC)] with centers in the North American National Trauma Data Bank (NTDB). Patients (≥16 years) with blunt/penetrating injuries were included. Multivariable logistic regression, adjusting for known predictors of trauma mortality, was performed. Estimates were used to predict the expected deaths at each center and to calculate O/E mortality ratios for benchmarking.
  
  
  RESULTS
  A total of 375,433 patients from 301 centers were included from the NTDB (2002-2010). The LMIC trauma center had 806 patients (2002-2010), whereas the HIC reported 1,003 patients (2002-2004). The most important known predictors of trauma mortality were adequately recorded in all datasets. Mortality benchmarking revealed that the HIC center performed similarly to the NTDB centers [O/E = 1.11 (95% confidence interval (CI) 0.92-1.35)], whereas the LMIC center showed significantly worse survival [O/E = 1.52 (1.23-1.88)]. Subset analyses of patients with blunt or penetrating injury showed similar results.
  
  
  CONCLUSIONS
  Using only a few key covariates, aggregated global trauma data can be used to adequately perform international trauma center benchmarking. The creation of the ITDB is feasible and recommended as it may be a pivotal step towards improving global trauma outcomes.
authors.affiliation: Department of Surgery, Center for Surgical Trials and Outcomes Research, The Johns Hopkins School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Suite 6107, Baltimore, MD, 21287-4688, USA, ahaider1@jhmi.edu.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: Zain G
authors.initials: ZG
authors.lastname: Hashmi
authors.forename: Sonia
authors.initials: S
authors.lastname: Gupta
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.forename: Jean-Stephane
authors.initials: JS
authors.lastname: David
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: Kent A
authors.initials: KA
authors.lastname: Stevens
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Eric
authors.initials: E
authors.lastname: Voiglio
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000379:methods*; D016208:Databases, Factual; D019049:Developed Countries; D003906:Developing Countries; D005240:Feasibility Studies; D005260:Female; D005602:France; D014943:Global Health; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012042:Registries; D014193:Trauma Centers / Q000592:standards*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*; D014950:Wounds, Penetrating / Q000401:mortality / Q000628:therapy*; D055815:Young Adult