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

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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.