Appendix 1. The SIGN Database: Fields, Entry and Reporting
Surgeons in hospitals that use SIGN nails log on to the database[1] over the Internet and enter simple demographic details, details of the fracture, timing, and nature of the surgery. In addition they enter digital images of pre and postoperative radiographs and the sizes of the nail and interlocking screws. Many fields are mandatory; the implant data cannot be entered without demographic information. However, followup information is not mandatory.
The online surgical database application for the SIGN database is written in Microsoft’s Active Server Page (ASP) language. The web server on which the application is running is a Windows Server 2003, IIS 6. The database being used to store the data input through this application is Microsoft SQL 2005. The database currently includes data for over 26000 cases including approximately 80,000 radiographic images. This case load equates to about 200 MB of data with an additional 18 GB of storage required for the images which are stored on the same hard drive but not directly in the database. The database is password protected at multiple levels. Each institution has its own password. A data backup application is being used to backup the entire database on a daily basis.
Entry
The data collected on the SIGN database may include information on the case, the surgery, the fracture and the followup (Table 1). The surgeon or project manager of the treating hospital signs on to the database [1] over the Internet. Many of the fields require mandatory entries (Fig.1). The entry is not accepted until the information is entered.
The entry of the details of the case over the Internet includes the uploading of radiographic images. It is time-consuming, especially with slow or intermittent Internet connections. Some of the more successful SIGN programs have devolved this task onto a secretary.
Reporting.
In-house, the SIGN database reports are compared to a separate system which tracks manufacturing. By querying both systems, inventory status and restocking requirements are reported. This system protects patient privacy by reporting the information in batches rather than from individuals. The overall program director (LGZ) has permission to see all data and uses this for comments on surgical technique on individual cases.Program managers in various different hospitals have access to all the data from their institutions and use it to plan studies of the SIGN nail program locally. General access to a subset of the information may be granted to someone mounting a study. In that case certain information (eg Patients’, Hospitals’ and Surgeons’ names) is not available in the set of information available to general inquiry (Table 1).
The database can be searched with multiple fields. For example, one can discover 34 patients who presented for SIGN surgery with a nonunion after previous external fixation and have been followed up (Fig.2).
References
- SIGN Database Website. Available at: Registration and password available only from the SIGN program. Accessed April 17, 2010.
Legends
Fig. 1This is an example of an entry form to the SIGN Database.
Fig. 2This is an example of a search of the SIGN Database using multiple parameters.