Standardizing the standards

The maintenance of a database for trauma patients is mandated for trauma center accreditation however there is no further standardization beyond that.2 The importance of restarting this database has been emphasized by Canadian trauma surgeons. The relatively random nature of these 5 universal complications emphasizes the need for greater standardization of pertinent quality improvement measures. Currently, the National Trauma Databank (NTDB) and Trauma Quality Improvement Program (TQIP) include Canadian Centers but they were not included in this review.3 These databases have allowed the US to create benchmarks for programs to strive for and make targeted plans for quality improvement.3 In the United States, the American College of Surgeons is responsible for trauma center verification and this verification mechanism is used less commonly north of the border.3 In Canada, Accreditation Canada designates Canadian Trauma Centers using set trauma system and trauma center standards developed by the Trauma Association of Canada.4 The core indicators used include field triage, wait time for rehabilitation, trauma team activation, emergency department/acute care length of stay, complications, and mortality.4 The billing for Canadian Healthcare and the US Healthcare systems is very different as Canada has a publicly funded system, thus data on exact trauma costs are more challenging to determine.5 However research into this has shown that major trauma in Canada is also associated with high costs.5 This could be a motivating factor to reinvigorate the Canadian trauma registry and rationale to provide additional funding for this registry with the long term goal of reducing cost via quality improvement and benchmarking.