Draft:Swedish Fracture Register
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The Swedish Fracture Register (SFR) is a national quality register (NQR) that tracks patient outcomes following a fracture and aims to improve fracture care. The register now has > 900,000 fractures registered and more than 65 scientific publications. The SFR is a unique source in orthopedic research since it contains data on fracture classification, non-surgical or surgical treatment, re-operations, and patient-reported outcomes.[1]
Background
[edit]Sweden has a long tradition of National Quality Register' in health care, for example, the Knee Arthroplasty Register and the Hip Arthroplasty Register, both launched in the 1970s. They have contributed to research and developed arthroplasty surgery to be much safer for the patient.[2][3] Quality registers are an important complement to randomized controlled trials when those are not ethical to perform, or the cohort is too small to detect problems.[4] Value-based health care with patient-reported outcomes is today an important keystone when we validate which treatment is most suitable for each patient and diagnosis[5]
At the beginning of 2000, some driving forces in the orthopedic department in Sahlgrenska, Gothenburg, recognized the need for a more systemized collection of data on fractures in Sweden. There was a gap of knowledge where we lacked proper information on fracture classification, injury mechanism, kind of treatment, complications, and patient-reported outcome. With the experience from the arthroplasty registers, they formed the variables and methodology of the SFR. At the beginning of 2011, the first patients and fractures were registered in Gothenburg, and since 2021, SFR has had full coverage in Sweden[6] The aim of the SFR is to follow outcomes in the aspect of re-operations and patient reported outcomes, and mortality.
Registration process
The registration takes place in three steps and is performed by an orthopedic surgeon, resident, or A&E doctor at the ER. It is totally web-based for the physician and the patient is invited to answer when the fracture is registered in step 1. The patient is identified with the Swedish identification number, which follows the patient throughout life and, enables collection of data from the medical charts and other registers in Sweden. The first step starts with registration of the injury mechanism, which implies low or high-energy trauma.[7]
The second step is the registration of the type of fracture, pathological, atypical, or related to an implant. Classification gives information on localization, ex. Forearm, spine, or ankle and a description of the specific pattern of the fracture. The classification gives us information on the severity of the fracture. The majority of the fractures are classified according to the Arbeitsgemeinschaft für Osteosynthesenfragen /Orthopaedic Trauma Association classification (AO/OTA),[8] and the user is guided by pictures with text.
The third and last step is registration of treatment. Both non-operative and operative is included and the latter includes specification of the chosen operative method. If further treatment, either planned subsequent or secondary treatment, is registered, it is linked to the initial fracture. Mortality is automatically transferred from the Tax Agency.
Patient-reported outcome
The SFR aims to evaluate the functional level of all patients registered one week before the accident and then one year after the accident through self-assessed questionnaires. The PROM' used is the Short Musculoskeletal Function Assessment (SMFA) and health-related quality of life is measured with the EQ5D-5L, which is a self-assessment scale from the Euro-QOL-group that aims to mirror health and functional level in general.[9] This is a validated, internationally widespread questionnaire to measure PROM of the locomotor organs, and its design makes it easy to use in community-based outcome studies. It consists of the dysfunction index, which measures the patient's function, and the bother index, which evaluates how the functional problems are a bother to the patient.
SFR of today
[edit]Today, completeness for most departments in the register is 75-95%. Every single user is authorized to look at data on their department to get statistics on which methods, patients, and diagnoses they treat. It is also possible to do national comparisons throughout Sweden's different departments. SFR now also provides care programs and recommendations on fractures such as distal radius and fractures in the ankle.
References
[edit]- ^ "Frakturregistret – syfte och funktionssätt - Svenska Frakturregistret". sfr.registercentrum.se. Retrieved 2024-10-05.
- ^ Herberts, Peter; Malchau, Henrik (January 2000). "Long-term registration has improved the quality of hip replacement: A review of the Swedish THR Register comparing 160,000 cases". Acta Orthopaedica Scandinavica. 71 (2): 111–121. doi:10.1080/000164700317413067. ISSN 0001-6470. PMID 10852315.
- ^ Knutson, Kaj; Robertsson, Otto (February 2010). "The Swedish Knee Arthroplasty Register (www.knee.se): The inside story". Acta Orthopaedica. 81 (1): 5–7. doi:10.3109/17453671003667267. ISSN 1745-3674. PMC 2856197. PMID 20170420.
- ^ Boyer, P.; Boutron, I.; Ravaud, P. (July 2011). "Scientific production and impact of national registers: the example of orthopaedic national registers". Osteoarthritis and Cartilage. 19 (7): 858–863. doi:10.1016/j.joca.2011.02.006. PMID 21362489.
- ^ Ahmed, Sara; Berzon, Richard A.; Revicki, Dennis A.; Lenderking, William R.; Moinpour, Carol M.; Basch, Ethan; Reeve, Bryce B.; Wu, Albert W. (December 2012). "The Use of Patient-reported Outcomes (PRO) Within Comparative Effectiveness Research: Implications for Clinical Practice and Health Care Policy". Medical Care. 50 (12): 1060–1070. doi:10.1097/MLR.0b013e318268aaff. ISSN 0025-7079. PMID 22922434.
- ^ Wennergren, David; Möller, Michael (2018-12-01). "Implementation of the Swedish Fracture Register". Der Unfallchirurg. 121 (12): 949–955. doi:10.1007/s00113-018-0538-z. ISSN 1433-044X. PMC 6280829. PMID 30178109.
- ^ Wennergren, David; Ekholm, Carl; Sandelin, Anna; Möller, Michael (2015-11-06). "The Swedish fracture register: 103,000 fractures registered". BMC Musculoskeletal Disorders. 16 (1): 338. doi:10.1186/s12891-015-0795-8. ISSN 1471-2474. PMC 4636773. PMID 26546157.
- ^ Meinberg, Eg; Agel, J; Roberts, Cs; Karam, Md; Kellam, Jf (January 2018). "Fracture and Dislocation Classification Compendium—2018". Journal of Orthopaedic Trauma. 32 (1): S1–S10. doi:10.1097/BOT.0000000000001063. ISSN 0890-5339. PMID 29256945.
- ^ SWIONTKOWSKI, MARC F.; ENGELBERG, RUTH; MARTIN, DIANE P.; AGEL, JULIE (September 1999). "Short Musculoskeletal Function Assessment Questionnaire". The Journal of Bone & Joint Surgery. 81 (9): 1245–60. doi:10.2106/00004623-199909000-00006. ISSN 0021-9355. PMID 10505521.