Injury Research
It has been demonstrated that people with life-threatening but potentially treatable injuries are up to six times more likely to die in a country with no organized trauma system than in one with an organized, resourced trauma system. Such evidence demonstrates the need for deployment of trauma systems especially in low and middle income countries where the burden of injury is on the rise. Trauma systems require a thorough understanding of the patterns of injury in a geographical area thus the importance of using databases to describe the epidemiology of injury and the access to quality surgical care. Such data can be used for the purposes of performance improvement, injury prevention and further policy measures to reduce the burden on injury and improve access to surgical care. Several registries have now been implemented in resource-limited settings.
In partnership with local universities and health care leadership, the CGS has deployed and instituted such databases in numerous countries around the world. These databases comprise:
Trauma Registry (TR)
Operating Room Registry (OR) including the Perioperative Mortality Rate (POMR)
The implementation of registries provides the earliest hospital-based injury epidemiology, which in turn informs future targeted interventions in education and prevention, addressees human and material resource gaps, and drives policy to attend to the challenges of injury.
The CGS’s previous innovation was the development and introduction of an electronic tablet application called iTrauma™ which allowed for real time data entry at the point of care. This app has been implemented in Tanzania, Malawi, Mozambique, Chile and Ukraine with plans to further expand. Currently, the most recent innovation is Amber, an electronic data collection system, which has already been implemented in Tanzania.
Amber is designed for low-resource settings, with features such as offline functionality, language translation, and simple customization. It enables quick, effective, and accurate data collection to track longitudinal data trends, supply benchmarking data, and uncover injury patterns and root causes. This leads to improved training, education, prevention, targeted interventions, and ultimately the quality of trauma care and health outcomes.
I had the exceptional opportunity to work with the CGS in two different countries.
In Senegal, I got to explore and analyze the prehospital system across the country, looking for ways to improve access to care. In Nepal, I helped implement a trauma registry in a few areas; I combined this project with a clinical elective in the emergency department.
These international experiences allowed me not only to gain invaluable knowledge from the local experts I worked with and to develop new skills, but also to create meaningful memories and lifelong friends. Kamil Michalski
Global Children's Surgery Research
If global surgery has been dubbed "the stepchild of global health", children's surgery remains "the unborn stepchild" of global health. The care of children with surgical diseases remains an under-appreciated and underfunded area in children’s healthcare. This shortcoming exists despite the fact that congenital anomalies make up 9% of the surgical burden of disease worldwide, of which two-thirds are likely to be avertable with surgical intervention. Trauma, abdominal emergencies, and tumors also contribute significantly to the burden of surgical disease for patients of all ages. In a world where some estimates attribute one third of all childhood deaths to a surgical condition, it is unrealistic to believe that we will achieve the SDG 3.2 to end preventable deaths of newborns and children under the age of five by 2030 without real investment and intervention in the realm of children’s surgery.
The "Global pediatric surgical lab" at Montreal Children's Hospital is the site for multiple research projects in global pediatric surgical research. These include studies on the burden of children's surgical disease, access to surgical care for children, metrics of burden of surgical disease, cost-effectiveness studies, and implementation studies.
The research team includes several pediatric surgeons, surgical residents working on their masters or PhD projects in global surgery, visiting surgeons from LMICs, and plenty of medical students interested in undertaking their first surgical research projects under close supervision.
The lab also offers the Jean-Martin Laberge Fellowship in Global Pediatric Surgical Research [link] to surgical residents and surgeons interested in pursuing a Masters' or a PhD in global surgical research and is associated to the Global Initiative for Children's Surgery (GICS) [link].
Recent Publications
2017
St-Louis E, Deckelbaum DL, Baird R, Razek T. Optimizing the assessment of pediatric injury severity in low-resource settings: Consensus generation through a modified Delphi analysis. Injury. 2017 Jun;48(6):1115–9.
St-Louis E, Séguin J, Roizblatt D, Deckelbaum DL, Baird R, Razek T. Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings. Pediatr Surg Int. 2017 Mar;33(3):299–309.
Madani A, Vassiliou MC, Watanabe Y, Al-Halabi B, Al-Rowais MS, Deckelbaum DL, et al. What Are the Principles That Guide Behaviors in the Operating Room?: Creating a Framework to Define and Measure Performance. Ann Surg. 2017;265(2):255–67.
2016
Sivakumaran L, Ayinde T, Hamadini F, Meterissian S, Razek T, Puckrin R, et al. Support infrastructure available to Canadian residents completing post-graduate global health electives: current state and future directions. Can Med Educ J. 2016 Dec;7(3):e41–50.
Ntakiyiruta G, Wong EG, Rousseau MC, Ruhungande L, Kushner AL, Liberman AS, et al. Trauma care and referral patterns in Rwanda: implications for trauma system development. Can J Surg. 2016 Feb;59(1):35–41.
2015
Pauyo T, Debas HT, Kyamanywa P, Kushner AL, Jani PG, Lavy C, et al. Systematic Review of Surgical Literature from Resource-Limited Countries: Developing Strategies for Success. World J Surg. 2015 Sep;39(9):2173–81.
Wong EG, Razek T, Elsharkawi H, Wren SM, Kushner AL, Giannou C, et al. Promoting quality of care in disaster response: A survey of core surgical competencies. Surgery. 2015 Jul;158(1):78–84.
Wong EG, Ntakiyiruta G, Rousseau MC, Ruhungande L, Kushner AL, Liberman AS, et al. Acute care surgery in Rwanda: Operative epidemiology and geographic variations in access to care. Surgery. 2015 Jul;158(1):37–43.
Wong EG, Deckelbaum DL, Razek T. Global access to surgical care: moving forward. Lancet Glob Health. 2015 Jun;3(6):e298-299.
Wong EG, Razek T, Luhovy A, Mogilevkina I, Prudnikov Y, Klimovitskiy F, et al. Preparing for Euro 2012: developing a hazard risk assessment. Prehosp Disaster Med. 2015 Apr;30(2):187–92.
Petroze RT, Byiringiro JC, Ntakiyiruta G, Briggs SM, Deckelbaum DL, Razek T, et al. Can focused trauma education initiatives reduce mortality or improve resource utilization in a low-resource setting? World J Surg. 2015 Apr;39(4):926–33.
Wong EG, Gupta S, Deckelbaum DL, Razek T, Kushner AL. Prioritizing injury care: a review of trauma capacity in low and middle-income countries. J Surg Res. 2015 Jan;193(1):217–22.
2010-2014
Deckelbaum DL, Gosselin-Tardif A, Ntakiyiruta G, Liberman S, Vassiliou M, Rwamasirabo E, et al. An innovative paradigm for surgical education programs in resource-limited settings. Can J Surg. 2014 Oct;57(5):298–9.
Wong EG, Gupta S, Deckelbaum DL, Razek T, Kamara TB, Nwomeh BC, et al. The International Assessment of Capacity for Trauma (INTACT): an index for trauma capacity in low-income countries. J Surg Res. 2014 Aug;190(2):522–7.
Gosselin-Tardif A, Butler-Laporte G, Vassiliou M, Khwaja K, Ntakiyiruta G, Kyamanywa P, et al. Enhancing medical students’ education and careers in global surgery. Can J Surg. 2014 Aug;57(4):224–5.
Deckelbaum DL, Ntakiyiruta G, Liberman AS, Razek T, Kyamanywa P. Augmenting surgical capacity in resource-limited settings. Lancet. 2012 Aug 25;380(9843):713–4.
Deckelbaum DL, Gosselin Tardif A, Gosselin Tardiff A, Taylor R, Howard A, Khwaja K, et al. Global health conferences: are they truly “global”? The Bethune Round Table paradigm for promoting global surgery. Can J Surg. 2011 Dec;54(6):422–9.
Deckelbaum DL. The Haiti earthquake: a personal perspective. CMAJ. 2010 Mar 23;182(5):E241-242.
2007-2009
Demyttenaere SV, Nansamba C, Nganwa A, Mutto M, Lett R, Razek T. Injury in Kampala, Uganda: 6 years later. Can J Surg. 2009 Oct;52(5):E146-150.
Deckelbaum DL, Feinstein AJ, Schulman CI, Augenstein JS, Murtha MF, Livingstone AS, et al. Electronic medical records and mortality in trauma patients. J Trauma. 2009 Sep;67(3):634–6.
Bergman S, Deckelbaum D, Lett R, Haas B, Demyttenaere S, Munthali V, et al. Assessing the impact of the trauma team training program in Tanzania. J Trauma. 2008 Oct;65(4):879–83.
Macleod JBA, Kobusingye O, Frost C, Lett R. Kampala Trauma Score (KTS): Is it a new triage tool? East and Central African Journal of Surgery. 2007 Jan 1;12(1):74–82.
Recent Presentations
2009-2014
Wong EG, Razek T, Elsharkawi H, Wren SM, Kushner AL, Giannou C, Khwaja KA, Beckett A, Deckelbaum DL. Assessing core surgical competencies in disaster response: a pilot survey. Canadian Association of General Surgeons’ Surgery Forum - Resident Research Retreat. September 17th 2014. Vancouver, Canada.
Wong EG, Groen RS, Kamara TB, Cassidy LD, Samai M, Deckelbaum DL, Razek T, Kushner AL, Wren SM. Burn injuries in Sierra Leone: A population-based assessment. West African College of Surgeons Annual Meeting. February 24th 2014. Kumasi, Ghana.
Wong EG, Gupta S, Deckelbaum D, Razek T, Nwomeh B, Kamara TB, Kushner AL. Development of the International Assessment of Capacity for Trauma (INTACT) Index: An initial implementation in Sierra Leone. Academic Surgical Congress. February 5th, 2014. San Diego, USA.
Gupta S, Wong EG, Deckelbaum D, Razek T, Nwomeh B, Kushner AL. Burn management capacity in low and middle-income countries: A review of 531 hospitals across 17 countries. Academic Surgical Congress. February 4th, 2014. San Diego, USA.
Wong EG, Razek T, Luhovy A, Mogilevkina I, Kolesnik V, Prudnikov Y, Klymovitskyy F, Yutovets Y, Khwaja K, Deckelbaum DL. Preparing for Euro 2012: Developing a hazard risk assessment. World Congress on Disaster and Emergency Medicine. May 29th, 2013, Manchester, United Kingdom.
Deckelbaum DL, Gmora SB, Dingemans E, Exe C, MD; Flores R, Rawson I, Neusy AJ, Mulder DS, MD; Razek T. The use of peripheral treatment centres during natural disasters: an essential adjunct to disaster relief. Panamerican Trauma Society XIII Annual Meeting. Montevideo, Uruguay. November 10-13, 2010.
Razek T. Trauma Surgery in Third World Environments. The Trauma Association of Canada Annual Scientific Meeting. Halifax, Canada. May 6-7, 2010
Gill H, Rousseau M, Ng J, Boniface R, Khwaja K, Razek T. Is the Kampala Trauma Score useful for North America? Trauma Association of Canada Annual Scientific Meeting Halifax, May 2010
Deckelbaum DL, Fata P, khwaja K, Razek T. Injury and emergency surgical education: where we are and where we need to be. Global Health Education Consortium. Cuernavaca, Mexico. April 9-11, 2010
Rousseau M, Gill H, Bourque M, Desloges W, Mackechnie M, Boniface R, T. Razek. External Validation of the Kampala Trauma Score. International Surgical Week. Adelaide, Australia. September, 2009
Razek T, Rousseau M, Gill H, Lett R, Mbembati N, Boniface R, Museru L. Streamlined Injury Databases and the Kampala Trauma Score - A global minimal Data Set with Powerful descriptive and quality assessment capacity. Consortium of Universities for Global Health, 2009 Annual Meeting. Bethesda, MD, USA