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Review of military and civilian trauma registries: Does consensus matter?

van Dongen, Thijs T.C.F. MD; de Graaf, Johan MD; Huizinga, Eelco P. MD; Champion, Howard R. MD; Hoencamp, Rigo MD, PhD; Leenen, Luke P.H. MD, PhD

Journal of Trauma and Acute Care Surgery: March 2017 - Volume 82 - Issue 3 - p 596–604
doi: 10.1097/TA.0000000000001341
Review Article

BACKGROUND Structural collection of data from combat injuries is important to improve provided care and the outcome of (combat) casualties. Trauma registries are used in civilian and military health care systems for systematic administration of injury data. However, these registries often use different methods of data management, compromising international comparison of trauma systems. The aim of this review is to aid in reaching international (coalition-wide) consensus for compatible data collection methods with uniform definitions, which is needed for transnational research and subsequent improvement of medical support organizations.

METHODS In this descriptive review, we analyzed different data sets from trauma systems within the American-European context, and included data variables from civilian and military trauma registries. These data sets were analyzed to identify a core set of variables fundamental to describing the tactical context, epidemiology, injury mechanism, injury severity, key treatment, and outcome.

RESULTS A total of 1,672 unique variables, of which 536 military specific, were identified and divided in 11 elemental categories of medical care (patient info, incident info, injury diagnoses, prehospital care, emergency department, imaging, surgical treatment, intensive care, ward, discharge and outcome) and three military-specific categories (forward medical evacuation, prehospital medical treatment facility, and discharge out of theater). A total of 203 key variables were identified and considered fundamental for effective (military) trauma research.

CONCLUSION Well-established and reliable trauma registries and databases are fundamental in (military) trauma care. We recommend implementation of a (concurrent) UN/NATO wide registry system with a track and follow-up system to further improve the quality of care and registration of casualties. Further research should focus on real time aids available on the battlefield and direct storage/upload in trauma databases in theater. Ultimately, sound and valid data support medical decision process and evaluation necessary to save lives on the battlefield.

Supplemental digital content is available in the text.

From the Royal Netherlands Airforce and Department of Trauma, Division of Surgery (T.v.D), University Medical Center Utrecht; Defense Healthcare Organisation (J.d.G.), Department of Surgery (E.H.), Central Military Hospital, Ministry of Defense, Utrecht, the Netherlands; Department of Surgery (H.C.), SimQuest Solutions Inc, Annapolis and Uniformed Services University of the Health Sciences, Bethesda, Maryland; Royal Netherlands Navy (R) and Departments of Traumatology and Vascular Surgery, Division of Surgery (R.H.), Haaglanden Medical Center, The Hague; and Division of Surgery, Department of Trauma, (L.L.), University Medical Center Utrecht, Utrecht, Netherlands.

Submitted: September 29, 2016, Revised: November 6, 2016, Accepted: November 9, 2016, Published online: January 3, 2017.

The opinions and assertions expressed in this article are the private views of the authors and do not necessarily reflect and are not to be construed as the official policy, opinion or position of the Royal Netherlands Navy, the Ministry of Defense or the Government of The Netherlands.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Thijs T.C.F. van Dongen, Department of Trauma, Division of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3585 GA Utrecht, The Netherlands; email:

© 2017 Lippincott Williams & Wilkins, Inc.