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目的:拟建立中山市的创伤数据采集系统,并在全市推行,最终建立中山市创伤数据库,为中山市创伤的防治提供全面准确的资料。方法:建立专业的表格式院前创伤病历,在医院病历系统、院前创伤病历系统和创伤数据库2.0之间建立数据接口,实现数据共享,建立中山市创伤数据库。结果:通过院前病历系统完成本市急救中心2011-2013年创伤病例3257例,资料全面准确,创伤数据库具备统计分析、检索查询、资料共享等功能,并与院内病历系统兼容,实现了院前、院内患者资料信息一体化。结论:中山市创伤数据库的建立保证了创伤数据资料的完整性、准确性,为下一步建立创伤三级救治网络可靠的临床资料和基础,从而有望提高中山市创伤救治的效率和效果。
OBJECTIVE: To establish a data acquisition system of trauma in Zhongshan and to promote it in the whole city. Finally, a database of traumatic injuries in Zhongshan will be established to provide comprehensive and accurate information for the prevention and treatment of trauma in Zhongshan. Methods: To establish a professional form of pre-hospital traumatic medical records, establish a data interface between the hospital medical records system, pre-hospital trauma records system and trauma database 2.0, to achieve data sharing and establish Zhongshan trauma database. Results: 3257 cases of trauma from 2011 to 2013 in our emergency center were completed through the pre-hospital medical record system. The data were comprehensive and accurate. The database of traumatic injury was provided with such functions as statistical analysis, search and query, data sharing and compatibility with hospital medical record system, Hospital information integration of patient information. Conclusion: The establishment of Zhongshan trauma database ensures the integrity and accuracy of the trauma data. It is expected to improve the efficiency and effectiveness of trauma treatment in Zhongshan in order to establish reliable clinical data and foundation for the next-stage trauma tertiary treatment network.