The trauma laparotomy—A key procedure that lacks global data

摘要

Trauma accounts for approximately 9% of all global deaths, more than malaria, HIV, and tuberculosis combined.1 It disproportionately affects individuals of working age, with concurrent high disability and mortality rates that result in wide-ranging economic impacts. Paradoxically, resource-poor areas have the highest rates of trauma but also have the worst outcomes. Consequently, there is a strong argument for optimizing trauma care in these regions, in terms of both health and economic outcomes. In managing abdominal trauma, the laparotomy remains a key procedure worldwide, providing life-saving intervention in cases where there is evidence of uncontrolled hemorrhage or a hollow viscus perforation. The laparotomy has previously been defined as a “Bellwether” procedure, as a marker of a surgical system's ability to provide safe-surgical care.2 However, patient-level data for those undergoing a trauma laparotomy globally is currently limited. Using the trauma laparotomy as a surrogate marker for the ability of a health system to deliver trauma care provides an opportunity to better understand the need for trauma systems development worldwide. The Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) Study aims to provide a response to this call. The GOAL-Trauma Study is a planned multi-center global observational study focusing on trauma laparotomy patients, aiming to evaluate the patient and injury factors, their clinical management, and postoperative outcomes. The GOAL-Trauma study has been designed and developed with involvement from a wide variety of clinicians and academics involved in trauma care globally, across a wide range disciplines. The study design follows the success of similar surgical collaborative groups, including the Trauma Emergency Laparotomy Audit (TELA),3 the GlobalSurg Collaborative (www.globalsurgeryunit.org), and the Global Neurotrauma Outcomes Study (GNOS),4 whereby collaborators from across the world will contribute prospectively collected data from their respective hospitals. The data submitted will then be combined and analyzed together to provide a global perspective on the ability of surgical systems to deliver trauma care, benchmarked against a Bellwether procedure. The study will run between April 2024 and December 2024, aiming to recruit over 500 patients from approximately 150 hospitals globally, with all countries worldwide able to participate. Patients of any age who present at any hospital with a blunt or penetrating injury and undergo a trauma laparotomy within 5 days of presentation to the treating center are eligible for inclusion in the study. These patients will be followed up for 30 days post-operatively (or until discharge or death) and their data will be submitted through a secure online platform, REDCap. The GOAL-Trauma study will collect key patient-level and hospital-level data from across the patient healthcare journey, from the pre-hospital phase through to patient rehabilitation, mapping out the full trauma patient pathway and the key parameters involved. As an example, main time points of the patient's healthcare journey, the injuries sustained and procedures performed, and the post-operative recovery will be captured for every patient, providing a comprehensive and inclusive picture of their healthcare journey. Indeed, trauma patients undergoing laparoscopic, robotic, or interventional radiological procedures are not included, as these interventions are not globally available, so this ensures that the data set provides the clearest picture on trauma provision and pathways worldwide. Each site will also be required to complete a Center Questionnaire detailing key parameters of their hospital, providing a richer data set that will complement much of the quantitative information captured from the core data fields. Recruitment of study collaborators and contributing centers has already begun, using both existing research networks and global communication channels, with supp