Department of Surgery, University of North Carolina at Chapel Hill.
Kamuzu Central Hospital, Lilongwe, Malawi.
Injury. 2020 Jul;51(7):1548-1553. doi: 10.1016/j.injury.2020.04.044. Epub 2020 May 11.
Trauma is a leading cause of morbidity and mortality globally, with a disproportionate burden affecting low- and middle-income countries (LMIC). Rapid urbanization and differences in transportation patterns result in unique injury patterns in LMIC. Trauma registries are essential to determine the impact of trauma and the nature of injuries in LMIC to enable hospitals and healthcare systems to optimize care and to allocate resources.
A retrospective database analysis of prospectively collected data in the Kamuzu Central Hospital (KCH) Trauma Registry from 2018 - 2019 was performed. Activity-based costing, a bottom-up cost analysis method to determine the cost per patient registered, was completed after systematically analyzing the standard operating procedures of the KCH trauma registry.
During the study period, 12,616 patients were included in the KCH Trauma Registry. Startup costs for the trauma registry are estimated at $3,196.24. This sum includes $1815.84 for personnel cost, $200 for database initiation (REDCap database), $342.50 for initial data clerk training, and $787.90 for registry and office supplies. Recurrent costs occurring in 2018, included personnel, technology, supply, and facility costs. Five data clerks, one data clerk manager, and a registry manager are required for 24/7 data collection, data integrity, and database maintenance, with an estimated cost of $29,697.24 per year. Yearly recurrent data clerk training costs are $137.00. Internet and facility costs for a data clerk office and secure record storage are $1632.60 per year. Supplies for the completion of trauma intake forms (binders, paper, pens) are $1431.80 per year. The total annual cost of the trauma registry at a tertiary hospital in Malawi is $33,361.64, which costs $2.64 per patient registered in the registry in 2018.
Trauma registries are necessary for the assessment of the local trauma burden and injury pattern, but require significant financial commitment and time. To fully capture the local burden of trauma in resource-limited settings, acquiring, validating, and analyzing accurate data is crucial. Anticipating the financial burden of a trauma surveillance registry ahead of time is imperative.
创伤是全球发病率和死亡率的主要原因，中低收入国家（LMIC）的负担不成比例。快速城市化和交通模式的差异导致 LMIC 中出现独特的伤害模式。创伤登记册对于确定创伤的影响和 LMIC 中伤害的性质至关重要，这使医院和医疗保健系统能够优化护理并分配资源。
对 2018 年至 2019 年期间卡姆祖中央医院（KCH）创伤登记处前瞻性收集数据的回顾性数据库进行了分析。使用基于活动的成本核算方法，对 KCH 创伤登记处的标准操作程序进行系统分析后，确定了每位登记患者的成本。
在研究期间，共有 12616 名患者被纳入 KCH 创伤登记处。创伤登记处的启动成本估计为 3196.24 美元。这一数字包括 1815.84 美元的人员成本、200 美元的数据库启动（REDCap 数据库）、342.50 美元的初始数据录入员培训以及 787.90 美元的登记处和办公用品。2018 年发生的经常性成本包括人员、技术、供应和设施成本。需要 5 名数据录入员、1 名数据录入员经理和 1 名登记处经理来进行 24/7 的数据收集、数据完整性和数据库维护，每年的估计费用为 29697.24 美元。每年的数据录入员培训费用为 137.00 美元。数据录入员办公室和安全记录存储的互联网和设施费用为每年 1632.60 美元。每年完成创伤入院表格所需的用品（活页夹、纸张、笔）费用为 1431.80 美元。马拉维一家三级医院的创伤登记处的总成本为 33361.64 美元，2018 年登记处每名患者的登记费用为 2.64 美元。
创伤登记册对于评估当地创伤负担和伤害模式是必要的，但需要大量的财务承诺和时间。要充分了解资源有限环境下的创伤负担，必须获取、验证和分析准确的数据。预先预测创伤监测登记处的财务负担至关重要。
