Understanding the Global Burden of Disease of Skeletal Fractures: the International Orthopaedic Multi-Center Study (INORMUS)

项目总结 创伤是生命最初40年的主要死亡原因，每一个人死于 受伤时，多个人将永久残疾。肌肉骨骼损伤非常常见。 创伤的表现，发生在60%以上的受害者身上。考虑到人类苦难的程度和社会 与这些伤害相关的成本，有必要确定改善患者预后的关键目标 在肌肉骨骼创伤之后。世界卫生组织《全球道路交通安全报告(2013)》， 针对正在进行的道路交通安全十年，建议注重研究和干预 在中低收入国家(LMIC)，目标是使用循证解决方案来预防 受伤后的并发症。我们正在进行一项大型的全球前瞻性队列研究(INORMUS) 肌肉骨骼创伤患者。我们有资金在非洲和亚洲招募3.5万名患者。这个 目前的提案要求额外的关键资金来从拉丁美洲招募5,000名患者，以实现我们的 全球目标样本量为40,000名患者。INORMUS的目标是确定，在出席的成年人中 肌肉骨骼损伤的入院治疗：1)损伤机制及早期治疗细节 2)主要并发症(死亡率、再手术和感染)的发生率 入院后30天；3)可更改和不可更改的患者、系统和治疗因素 与这些主要并发症有关。所有18岁或以上的患者到招募诊所就诊 3个月内发生的骨科损伤的治疗地点有资格参加。在获得后 知情同意，研究人员获得关于损伤机制、早期治疗和运输的信息，以及 可能预测重大并发症的患者特征。我们对研究参与者进行了30次跟踪调查 入院后天数，并评估每个患者的研究结果。Inormus的研究将提供 对肌肉骨骼创伤负担和损伤机制的至关重要的估计，以解决正在进行的 世界各地的知识差距，从而使世卫组织等组织能够优先采取最紧迫的行动 道路交通伤害预防倡议的项目。确定与患者和系统级别相关的因素 重大并发症将使医生能够更好地识别和护理高危患者，并使 知识领袖游说战略分配资源，以改善肌肉骨骼损伤的预后 病人。此外，鉴于创伤模式和结果在人群中的一致性，这些结果将 不仅在小岛屿发展中国家，而且在资源丰富的国家，提供关键信息。INORMUS的研究与此一致 与NIH的战略计划一起支持研究，这些研究将为未来临床试验的发展提供信息 评估挽救生命和肢体的干预措施。

PROJECT SUMMARY Trauma is the leading cause of death in the first 4 decades of life and, for every person killed as a result of an injury, multiple individuals are left permanently disabled. Musculoskeletal (MSK) injuries are highly common manifestations of trauma, occurring in over 60% of victims. Given the degree of human suffering and societal costs associated with these injuries, there is a need to identify key targets for improving patient outcomes following musculoskeletal trauma. The World Health Organization's Global Road Traffic Safety Report (2013), in response to the ongoing Decade of Road Traffic Safety, recommended a focus on research and interventions in low-middle income countries (LMICs) with the goal of using evidence-driven solutions to prevent complications following injuries. We are conducting a large, global prospective cohort study (INORMUS) in patients with musculoskeletal trauma. We have funding to enroll 35,000 patients across Africa and Asia. The current proposal requests additional critical funds to enroll 5,000 patients from Latin America to achieve our global target sample size of 40,000 patients. INORMUS aims to determine, among adult individuals who present to hospital with musculoskeletal trauma, the following: 1) mechanisms of injury and details of early treatment and transport to hospital; 2) the incidence of major complications (mortality, re-operation and infection) within 30 days post-hospital admission; and 3) modifiable and non-modifiable patient, system, and treatment factors associated with these major complications. All patients 18 years of age or older who present to a recruiting clinical site for treatment of an orthopaedic injury that occurred within 3 months are eligible for participation. After obtaining informed consent, study personnel obtain information on mechanism of injury, early treatment and transport, and patient characteristics that are potential predictors of major complications. We follow study participants for 30 days post-hospital admission and assess each patient for the study outcomes. The INORMUS study will provide critically important estimates of musculoskeletal trauma burden and mechanism of injury to address ongoing knowledge gaps worldwide, thus enabling organizations such as the WHO to prioritize the most imperative action items of the road traffic injury prevention initiative. Identification of patient and system level factors associated with major complications will allow physicians to better identify and care for at-risk patients and enable knowledge leaders to lobby for strategic allocation of resources to improve outcomes for musculoskeletal injury patients. Further, given the consistencies in trauma patterns and outcomes across populations, these results will provide critical information, not only in LMICs, but also in well-resourced countries. The INORMUS study aligns with the strategic plan of the NIH to support studies that will inform the development of future clinical trials to evaluate life and limb saving interventions.