state to state, most registries include only "major" trauma patients and generally exclude patients who survive and stay in the hospital less than three days. Further, some trauma registries do not include drowning, poisoning, and/or suffocation. Typically, however, deaths are included regardless of whether they occur in the emergency department or after admission to the hospital. Most statewide registries collect data only from trauma centers. The American College of Surgeons has developed a minimum data set recommended for use by all trauma centers in developing their registries. Efforts are also under way to establish a National Trauma Data Bank (NTDB) that will collate data from trauma centers and trauma systems across the country (G. Strauch, American College of Surgeons, personal communication, 1998). When fully operational, the NTDB, will be a valuable resource to injury researchers. In general, trauma registries can provide useful information, especially for continuous quality improvement initiatives and clinical research (Rutledge, 1995). However, it is important to remember that not all are population based, and some typically exclude data on "nonmajor" trauma and on trauma not treated at trauma centers; thus they are not as useful for evaluating the epidemiology of trauma or trauma systems evaluation (see Chapter 6). Perhaps the most limiting characteristic of most trauma registries is the lack of information about outcomes other than hospital morbidity and mortality. However, if registry data are kept for several years, over time, outcomes could be examined.

A recurrent theme of this report is that priority should be directed to the development of better information on the epidemiology, treatment, and outcomes of nonfatal injuries. As more lives are saved due to more effective prevention and regionalization of care, attention is shifting from a singular focus on survival as the criterion of success, to a detailed consideration of nonfatal outcomes as well. Extending the current concept of a trauma registry to include information on longer-term and nonfatal outcomes provides an excellent opportunity to begin developing this information for trauma patients. Considerable effort has been focused, over the past several years, on developing shorter, less time-consuming instruments to gather the necessary data. It will be important to evaluate these newer instruments for their sensitivity and responsiveness to a broad range of trauma patients. Further, effective and efficient systems for tracking patients are needed so that, at specified times following an injury, an assessment of outcomes can be made for patients who received or did not receive acute care. Guidelines for developing and maintaining these registries are critical and should include recommendations regarding specific outcome measures, supplementary data needed to interpret outcomes, methods for routinely tracking and assessing patients, the optimal timing of assessments, and approaches for summarizing and using data on outcomes. Information on long-term outcomes has to be uniformly collected. Attention to issues of data quality, privacy, and confidentiality must be carefully addressed.

The committee strongly urges extending the use of established trauma registries to monitor outcomes following injury. A consensus panel should be con-

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