National Trauma Data Standard: Everything youve wanted to know but have been afraid to ask

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National Trauma Data Standard Everything youve
wanted to know but have been afraid to ask!
N. Clay Mann, PhD, MS
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Objectives

• Need for a National Registry
• The State of State Registries
• Variability in Data Quality
• Development of the NTDS
• Implementation of NTDS

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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

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States with Statewide Registries
Planning CA, DC, ID, KY, LA, ME, MA, MI, NE,
NM, TN, WV, WI
Technical Difficulties ND, SD
No Plans HI, IN, NH, NJ, RI, VT
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States with Registries

• 27/32 require hospitals to report
• 11 statesall acute care hospitals
• 15 statesonly designated centers
• 1 stateonly participating hospitals
• 5/32 request hospitals report
• 2 statesall acute care hospitals
• 1 stateonly designated centers
• 2 statespartial registries

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Variation in Case Acquisition
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Threats to Data Integrity

• Mandatory/elective Submission
• Completeness of Case Capture
• Difference in Case Definition
• Difference in Coding Conventions

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Are Registries Comparable?
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Variability in Case Definition

• Inclusion Criteria Number
  Exclusion Criteria Number
• Abuse 4
  Abuse 3
• Blisters, contusions, Blisters, contusions,
• abrasions 3
  abrasions 11
• Drowning 13 Drowning 15
• Smoke inhalation 7 Smoke inhalation
  2
• Foreign bodies 5 Foreign bodies
  17
• High altitude sickness 0 High altitude
  sickness 1
• Lightning 5 Lightning
  0
• Same level fall 2 Same level fall
  18
• Poisoning 2 Poisoning 13

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Variability in Case Definition

• Variability in same-level fall exclusion
• Same level fall AND age gt 55 yrs old
• Same level fall AND age gt 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 (ICD-9 808.2)
• Same level fall AND superficial injury (ICD-9
  910-924)
• Same level fall AND age gt 65 yrs old AND isolated
  hip fracture (ICD-9 820)
• Same level fall AND age gt 65 yrs old AND isolated
  extremity fracture (no ICD-9 codes listed)

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Variability in Coding Conventions
Glasgow Coma Score in ED

• 15 states..initial GCS
• 8 states..initial and last GCS
• 1 state...worst GCS
• 1 state best GCS
• 1 state..initial and worst GCS

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Variability in Coding Conventions
Time of Injury

• Coding Convention Number of States
• Report Not documented 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 (lt 1 hour, 1-6 hours,
• 7-12 hours, 13-24 hours, or gt24 hours)
  1

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Data Needs for Registries

• 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

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Existing National Registry

• Annual Report
• NTDB Pediatric Report
• NTDB Slide Kits
• Hospital Benchmark Reports
• Trauma Center Data Report Cards
• ACS Bulletin Articles

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• 2007
• NTDB contains over 2.7 million records
• From 900 US trauma centers
• Annual Report Version 7.0 released

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National Trauma Data Standard
2.2
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The Bank The Currency
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National Trauma Data Standard

• Standard Inclusion Criteria
• Standard Data Definitions
• Standard Source Hierarchy
• Standard Comorbidities
• Pediatric specific additions
• Auto-Calculated Fields
• Edit Checks
• The Validator

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Ensuring Common Variables

• Common Subset of Variables
• Evaluate variable frequency across registries
• Consider importance at national level
• Seek consensus from experts

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Variable Schema
Primary Variable
Supportive Variable
Autogenerated Variable
Secondary Variable
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Auto-generated Variables

• 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

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Choosing Inclusion Criteria

• Uniform Inclusion Criteria
• Collect all state inclusion/exclusion criteria
• Assess criteria for commonalities
• Look for least common denominator?

States
Criterion
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NTDS Inclusion Criteria
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Improving Data Quality
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NTDS Edit Checks
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Development of the Validator
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National Trauma Data Standard
THE VALIDATOR
Hasta La Vista Bad Data
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Benefit of a Common XML
NTDB
NEMSIS
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Improving Data Usability
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On Line Data Submission
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Facility Demographics

• Expanded Facility information screens
• 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

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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

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Data Submission
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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.

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We need your support!

• National Trauma Data Standard will
• 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!

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Tasks Seem Overwhelming?
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Technical Assistance

• Visit the website
• Join the NTDS Google Group
• Talk with your software vendors
• Utilize resources at the ACS and NEMSIS TAC

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www.ntdsdictionary.org/
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Join the NTDS Google Group!
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www.ntdb.org
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For More Information

• www.ntdb.org
• www.ntdsdictionary.org
• www.ntdbdatacenter.com

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Additional Questions

• Contact
• N. Clay Mann
• clay.mann_at_hsc.utah.edu
• [phone]
• Melanie Neal
• MNeal_at_facs.org
• [phone]

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How do we get here from there?
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Questions