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The trials of being a national trauma registry
  1. Karim Brohi
  1. Correspondence to Dr Karim Brohi, Centre for Trauma Sciences, Queen Mary University of London, London E1 2AT, UK; k.brohi{at}qmul.ac.uk

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Data and research sit at the heart of public health models of healthcare systems. It is not an exaggeration to state that no meaningful change is possible without the underlying knowledge that change is first necessary, and subsequent confirmation that change was effective. Only in this way can health systems bootstrap themselves up to effective high quality care. Trauma registries have therefore been at the heart of trauma systems since the concept was first introduced nearly half a century ago.

The Trauma Audit and Research Network (TARN) is now the central trauma registry for England and Wales and is deeply embedded in the structure and functioning of the regional major trauma centres and trauma networks. TARN arguably represents the most integrated, responsive and mission-critical trauma registry in the world. However, being a national trauma registry comes with many challenges, demands and limitations. Providers and users of the system must appreciate and manage these aspects of TARN for maximal effective use of the data and for the development of TARN itself.

Mission creep is the scourge of trauma registries. At their core, trauma registries exist to inform the trauma centre or trauma system's performance improvement programme. However, over time, others see the potential utility of the data and the users and stakeholders expand, each placing slightly different demands on the registry. Thus audit leads to research, research leads to health service delivery, delivery leads to commissioning, and all roads lead to finance. These demands exist at multiple levels—individuals and departments within an institution, the trauma centre itself, the regional network and supra-regional or national programmes. Each user group would like a few more fields added to the registry, not appreciating the additive cost and effort in collecting each single data point. It is conceptually a lot easier to add a field …

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