Transcript Coverage and Comparability of Statewide Trauma Registries

National Trauma Data Standard:
Everything you’ve wanted to know
but have been afraid to ask!
N. Clay Mann, PhD, MS
Objectives
• Need for a National Registry
• The State of State Registries
• Variability in Data Quality
• Development of the NTDS
• Implementation of NTDS
Need for a National Registry
• Provide a national resource for clinical
benchmarking, process improvement,
and patient safety
• Characterize all patient care
• Provide baseline measures for
enhancing disaster preparedness
• Develop better injury scoring and
outcome measures
• This is not necessarily surveillance
States with Statewide Registries
Submission to state
No
Planning – CA, DC, ID, KY,
LA, ME, MA, MI, NE, NM,
TN, WV, WI
No Plans – HI, IN, NH, NJ,
RI, VT
Yes
Technical Difficulties – ND, SD
States with Registries
• 27/32 require hospitals to report
– 11 states…all acute care hospitals
– 15 states…only designated centers
– 1 state…only participating hospitals
• 5/32 request hospitals report
– 2 states…all acute care hospitals
– 1 state…only designated centers
– 2 states…partial registries
Variation in Case Acquisition
Threats to Data Integrity
• Mandatory/elective Submission
– Completeness of Case Capture
• Difference in Case Definition
• Difference in Coding Conventions
Are Registries Comparable?
Variability in Case Definition
Inclusion Criteria
Abuse
Blisters, contusions,
abrasions
Drowning
Number
4
3
13
Exclusion Criteria
Number
Abuse
Blisters, contusions,
abrasions
3
11
Drowning
15
Smoke inhalation
7
Smoke inhalation
2
Foreign bodies
5
Foreign bodies
High altitude sickness
0
High altitude sickness
1
Lightning
5
Lightning
0
Same level fall
2
Same level fall
18
Poisoning
2
Poisoning
13
17
Variability in Case Definition
• Variability in “same-level fall” exclusion
– Same level fall AND age > 55 yrs old
– Same level fall AND age > 65 yrs old
– Same level fall AND isolated hip fracture (ICD-9 820)
– Same level fall AND fracture of the vertebral column
(ICD-9 805)
– Same Level fall AND isolated fracture of the pelvis (ICD9 808.2)
– Same level fall AND superficial injury (ICD-9 910-924)
– Same level fall AND age > 65 yrs old AND isolated hip
fracture (ICD-9 820)
– Same level fall AND age > 65 yrs old AND isolated
extremity fracture (no ICD-9 codes listed)
Variability in Coding Conventions
Glasgow Coma Score in ED
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15 states………..……initial GCS
8 states……..initial and last GCS
1 state………………...worst GCS
1 state………………… best GCS
1 state……..initial and worst GCS
Variability in Coding Conventions
Time of Injury
Coding Convention
Report “Not documented”
Number of States
10
Report EMS dispatch time
8
Report 5 minutes prior to EMS dispatch time
2
Report 15 minutes prior to EMS dispatch time
1
Report 5 to 20 minutes prior to EMS dispatch time
depending on call location and general scene info
1
Report EMS dispatch time only if MVC§
1
Report EMS arrival time
1
Report in categories (< 1 hour, 1-6 hours,
7-12 hours, 13-24 hours, or >24 hours)
1
Data Needs for Registries
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All States with Trauma Registries
Complete Data Capture
Common Subset of Variables
Uniform Data Definitions and Values
Standardized Coding Conventions
Common Definition of Injury
Uniform Inclusion Criteria
Existing National Registry
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Annual Report
NTDB Pediatric Report
NTDB Slide Kits
Hospital Benchmark Reports
Trauma Center Data Report Cards
ACS Bulletin Articles
2007
 NTDB contains over 2.7 million
records
 From 900 US trauma centers
 Annual Report Version 7.0 released
National Trauma Data Standard
2.2
The “Bank” The “Currency”
National Trauma Data Standard
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Standard Inclusion Criteria
Standard Data Definitions
Standard Source Hierarchy
Standard Comorbidities
 Pediatric specific additions
 Auto-Calculated Fields
 Edit Checks
 The “ Validator”
Ensuring Common Variables
• Common Subset of Variables
– Evaluate variable frequency across registries
– Consider importance at national level
– Seek consensus from experts
Variable Schema
Injury Information
Primary Variable
Injury Date/Time
Work Related
Supportive Variable
Patient's Occupational Industry
Patient's Occupation
Primary E-Code
Trauma Type (blunt, penetrating, burn)
Calculated field
Injury Intentionality (using CDC matrix)
Calculated field
Secondary E-Code
Additional E-Code
Incident Location Zip
Autogenerated Variable
Incident State
Incident County
Secondary Variable
Incident City
FIPS code-location code
Protective Devices
Child Specific Restraint
Airbag Deployment
Calculated field
Auto-generated Variables
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FIPS - like code (location code)
Trauma Type (blunt, penetrating, burn)
Injury Intentionality (using CDC matrix)
Total EMS Response Time
Total EMS Scene Time
Total EMS Time
Revised Trauma Score in the Prehospital Setting
(adult and pediatric)
Revised Trauma Score in ED (adult and pediatric)
Abbreviated Injury Scale (six body regions)
Injury Severity Score
International Classification Injury Severity Score
Functional Capacity Index
Total ED Time
Total Length of Hospital Stay
Choosing Inclusion Criteria
Uniform Inclusion Criteria
States
– Collect all state inclusion/exclusion criteria
– Assess criteria for commonalities
– Look for least common denominator?
Criterion
NTDS Inclusion Criteria
Improving Data Quality
NTDS Edit Checks
Development of the Validator
National Trauma Data Standard
THE “VALIDATOR”
“Hasta La Vista Bad Data”
Patient Care Report Software
Patient
Care
Report
Agency A’s Software
Patient
Care
Report
911
Center
Agency B’s Software
Patient
Care
Report
Agency C’s Software
Benefit of a Common XML
External Server
NTDS
NTDB
“Validator”
“Validator”
NEMSIS
Outcomes
Improving Data Usability
On Line Data Submission
Facility Demographics
• Expanded Facility information screens
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Hospital type
Hospital teaching status
Verification level
Bed Inventory
Inclusion criteria
Transfers in or out
Age of pediatric patients
Comorbidities and complications
Number of registrars
Number of surgeons
Software product utilized
Verification Requirement
 Annual NTDB participation
 Officially in effect with new green book
 Centers received waivers in 2007 as
needed
 Year round data submission started in 2008
Data Submission
Call for Data
2008
 First NTDB call for data based on
NTDS version 1.2
 Map current registry fields to the new
standard
2009
 Second NTDB call for data based on
NTDS version 1.2
 Updated software from vendors that
incorporates all the new data fields and
allows for direct data entry.
We need your support!
• National Trauma Data Standard will:
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Allow for seamless participation in NTDB
Describe severe trauma nationally
Characterize treatment and outcome
Assess trauma systems attributes
Link to standardized EMS data
• Vendors are also interested in your
commitment!
Tasks Seem Overwhelming?
Technical Assistance
• Visit the website
– Join the NTDS Google Group
• Talk with your software vendors
• Utilize resources at the ACS and
NEMSIS TAC
www.ntdsdictionary.org/
Join the NTDS Google Group!
www.ntdb.org
For More Information…
• www.ntdb.org
• www.ntdsdictionary.org
• www.ntdbdatacenter.com
Additional Questions
• Contact
– N. Clay Mann
[email protected]
(801) 585-9161
– Melanie Neal
[email protected]
(312) 202-5536
How do we get here from there?
Questions