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NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
National Trauma Data Bank 2008Pediatric Report
Version 8.0
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
NTDB Annual Report 2008
EditorsAvery B. Nathens, MD, FACS, Chair Richard J. Fantus, MD, FACS, Chair
National Trauma Data Bank Subcommittee Trauma Registry Advisory Ad Hoc Committee
American College of Surgeons Committee on Trauma LeadershipJohn J. Fildes, MD, FACS J. Wayne Meredith, MD, FACS Chair,
Committee on Trauma Medical Director, Trauma OfficeDivision of Research and Optimal Patient Care
National Trauma Data Bank StaffMelanie Neal, Manager
Sandra Goble, StatisticianChrystal Price, Coordinator
National Trauma Data Bank Subcommittee
Palmer Q. Bessey, MD, FACSKaren J. Brasel, MD, FACSDavid E. Clark, MD, FACSArthur Cooper, MD, FACS
Joseph Cuschieri, MD, FACSRichard J. Fantus, MD, FACS
Jeffrey S. Hammond, MD, FACSRichard J. Kagan, MD, FACS
Geoffrey R. Keyes, MD, FACSMichael D. McGonigal, MD, FACSFrederick H. Millham, MD, FACS
Allen F. Morey, MD, FACSCharles E. Morrow, Jr., MD, FACS
Michael L. Nance, MD, FACSAvery B. Nathens, MD, PhD, FACS
Manoj R. Shah, MD, FACSGlen H. Tinkoff, MD, FACS
N. Clay Mann, PhD, MS, Consultant
Pediatric Surgery Subspecialty GroupArthur Cooper, MD, FACS, Chair
Guy Brisseau, MD, FACSCharles S. Cox, MD, FACSMary E. Fallat, MD, FACSHenri R. Ford, MD, FACS
William D. Hardin, MD, FACSRichard J. Jackson, MD, FACSDavid P. Mooney, MD, FACSMichael L. Nance, MD, FACS
Kennith H. Sartorelli, MD, FACSL. R. Scherer, MD, FACS
Perry W. Stafford, MD, FACS
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
AcknowledgmentsThe American College of Surgeons Committee on Trauma wishes to thank the Centers for Disease Control and Prevention (CDC) for their support of the NTDB.
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Please note:The abbreviation NK/NR used on many tables denotes Not Known, Not Recorded, or Blank. If Not Applicable is not shown as a separate row on the table, then it is also included in the NK/NR category.
“Local ISS” denotes ISS scores submitted directly by hospitals regardless of the method of calculation. “ICD90 Derived” are scores derived by converting ICD9 codes to AIS using the ICD 90 Mapping program and then calculating ISS with the resulting AIS severity scores. “AIS Derived” are calculated from AIS submitted directly by hospitals. Analyses in this report use the ICD 90 Derived ISS.
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by AgeFigure
1A
Incidents by Age
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Age
Num
ber
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by AgeFigure
1B
Case Fatality Rate by Age
0.000.501.001.502.002.503.003.504.004.50
Age
Case
Fat
ality
Rat
e (%
)
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by Age and GenderFigure
2A
Incidents by Age and Gender
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
Age
Perc
ent
Female Male
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by Age and GenderFigure
2B
Case Fatality Rate by Age and Gender
01122334455
Age
Case
Fat
ality
Rat
e (%
)
Female Male
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Alcohol Use
0.005.00
10.0015.0020.0025.0030.0035.0040.0045.0050.00
No (confirmedby test)
No (notsuspected, not
tested)
Yes (confirmedby test [beyond
legal limit])
Yes (confirmedby test [trace
levels])
Not Applicable NK/ NR
Perc
ent
Figure3
Alcohol Use
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Drug Use Figure4
Drug Use
0.00
10.00
20.00
30.00
40.00
50.00
60.00
No (confirmedby test)
No (notsuspected, not
tested)
Yes (confirmedby test [illegal
use drug])
Yes (confirmedby test
[prescriptiondrug])
Not Applicable NK/ NR
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Primary Payment SourceFigure5
Primary Payment Source
0.005.00
10.0015.0020.0025.0030.00
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by Mechanisms of InjuryFigure
6A
Incidents by Mechanism of Injury
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
Motor VehicleTraffic
Fall Struck by,against
Transport,other
Firearm Cut/ pierce
Mechanism of Injury
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by Mechanism of InjuryFigure
6B
Case Fatality Rate by Mechanism of Injury
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
Motor VehicleTraffic
Fall Struck by,against
Transport,other
Firearm Cut/pierce
Mechanism of Injury
Case
Fat
ality
Rat
e (%
)
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by Mechanisms of Injury by AgeFigure7
Incidents by Mechanism of Injury by Age
0
1,000
2,000
3,000
4,000
5,000
6,000
<1year
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Age
Num
ber
Motor Vehicle Traffic Fall Struck by, against Transport, Other Firearm Cut/ pierce
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by Mechanism of Injury and Age
Figure8
Case Fatality Rate by Mechanism of Injury and Age
0.0010.0020.0030.0040.0050.00
<1year
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Age
Case
Fat
ality
Rat
e (%
)
MVT Fall Struck by, against Transport, Other Firearm Cut/pierce
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by Mechanism of Injury and GenderFigure
9A
Incidents by Mechanism of Injury and Gender
0.005.00
10.0015.0020.0025.0030.0035.0040.0045.00
MotorVehicleTraffic
Fall Struck by,against
Transport,other
Firearm Cut/ pierce
Mechanism of Injury
Perc
ent
Female Male
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by Mechanism of Injury and Gender
Figure
9B
Case Fatality Rate by Mechanism of Injury and Gender
0.002.004.006.008.00
10.0012.0014.00
MotorVehicleTraffic
Fall Struck by,against
Transport,other
Firearm Cut/ pierce
Mechanism of Injury
Case
Fat
ality
Rat
e (%
)
Female Male
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by Comparative Injury Severity Scores
Figure10
Incidents by Comparative Injury Severity Scores
0.0010.0020.0030.0040.0050.0060.0070.00
1–8 9–15 16–24 >24 NK/ NRInjury Severity Score
Perc
ent
Local ISS ICD90 Derived AIS Derived
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by Injury Severity ScoreFigure11
Case Fatality Rate by Injury Severity Score
0.00
5.00
10.00
15.00
20.00
25.00
30.00
1–8 9–15 16–24 >24 NK/ NRISS Categories
Case
Fat
ality
Rat
e (%
)
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by Injury Severity Score and AgeFigure12
Incidents by Injury Severity Score and Age
01,0002,0003,0004,0005,0006,0007,000
<1year
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Age
Num
ber o
f Cas
es
1-8 9-15 16-24 >24 NK/ NR
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by Injury Severity Score and Age
Figure13
Case Fatality Rate by Injury Severity Score and Age
0.0010.0020.0030.0040.0050.0060.00
<1year
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Age
Case
Fat
ality
Rat
e (%
)
ISS 1 –8 Case Fatality ISS 9–16 Case Fatality ISS 16–24 Case FatalityISS >24 Case Fatality NK/ NR Case Fatality
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by Work-Related InjuriesFigure
14A
Incidents by Work-Related Injuries
0.0010.0020.0030.0040.0050.0060.0070.0080.00
Yes No Not Applicable NK/ NR
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by Work-Related InjuriesFigure
14B
Case Fatality Rate by Work Related Injuries
0.00
1.00
2.00
3.00
4.00
5.00
6.00
Yes No Not Applicable NK/ NR
Case
Fat
ality
Rat
e (%
)
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by IntentFigure
15
Case Fatality Rate by Intent
0.002.004.006.008.00
10.0012.0014.00
Assault Self-inflicted Undetermined Unintentional Other NK/ NR
Case
Fat
ality
Rat
e (%
)
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by Location E-codeFigure16
Case Fatality Rate by Location E-code
0.000.501.001.502.002.503.003.504.004.50
Farm HomeIndustry
Mine OtherPublic Building
Recreation
Residential Institution
StreetUnspecified
Not Applicable
NK/NR
Case
Fat
ality
Rat
e (%
)
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by AIS Body RegionFigure
17
Incidents by AIS Body Region
-5.00
10.0015.0020.0025.0030.0035.0040.00
HeadFace Neck Thorax
AbdomenSpine
Upper Extremity
Lower Extremity
ExternalNK/ NR
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by AIS ≥ 3 by AIS Body RegionFigure
18
Incidents with AIS ≥ 3 by Body Region
-10.0020.0030.0040.0050.0060.00
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by AIS Body RegionFigure
19
Case Fatality Rate by AIS Body Region
-2.004.006.008.00
10.0012.00
HeadFace Neck Thorax
AbdomenSpine
Upper Extremity
Lower Extremity
ExternalNK/NR
Case
Fat
ality
Rat
e (%
)
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by Protective DevicesFigure
20
Incidents by Protective Devices
-5.00
10.0015.0020.0025.0030.00
NoneShoulder Belt
Lap BeltAirbag Present
Helmet (e.g. bicycle, skiing, motorcycle)
OtherProtective Clothing (e.g., padded leather pants)
Child Restraint (booster seat, child car seat)
Protective Non-Clothing Gear (e.g., shin guard)
Eye Protection
Personal Floatation Device
Not Applicable
NK/ NR
Protective Devices
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Median Total EMS Length (Mins) by Mechanism of Injury
Figure
21
Median Total EMS Length (Mins) by Mechanism of Injury
010203040506070
MVT Fall Struck by, against
Transport, other
FirearmCut/ pierce
Pedal cyclist, other
Hot object/substance
Other specified and classifiable
Fire/ flame
Unspecified
Natural/ environmental, Bites and stings
Pedestrian, other
Mechanism of Injury
Num
ber o
f Min
utes
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Median Total EMS Length (Mins) by Injury Severity Score
Figure
22
Median Total EMS Length (Mins) by ISS
42
44
46
48
50
52
1-8 9-15 16-24 >24
Injury Severity Score
Num
ber
of M
inut
es
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Median Length of Stay (Days) by Mechanism of Injury
Figure
23
Median Length of Stay (Days) by Mechanism of Injury
011223
MVT Fall
Struck b
y, again
st
Transport, ot
herFire
armCut/ p
ierce
Pedal cyclist
, other
Hot objec
t/ substance
Mechanism of Injury
Num
ber o
f Day
s
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Median Length of Stay (Days) by Injury Severity ScoreFigure
24
Median Length of Stay (in Days) by Injury Severity Score
01234567
1–8 9–15 16–24 >24
Injury Severity Score
Num
ber o
f Day
s
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Median Ventilator Days by Mechanisms of Injury
Figure
25
Median Ventilator Days by Mechanism of Injury
02468
101214
MVT Fall
Struck b
y, against
Transport,
other
Firearm
Cut/ pierc
e
Pedal cyc
list, other
Hot objec
t/substa
nce
Other specified and
classifiable
Fire/flame
Mechanism of Injury
Num
ber o
f Day
s
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Median Ventilator Days by Injury Severity ScoreFigure
26
Median Ventilator Days by Injury Severity Score
01234567
1–8 9–15 16–24 >24
Injury Severity Score
Num
ber o
f Day
s
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Median ICU Days by Mechanism of InjuryFigure
27
Median ICU Days by Mechanism of Injury
0
1
2
3
4
5
6
MVTFall
Struck by, against
Transport, other
FirearmCut/pierce
Pedal cyclist, other
Hot object/substance
Other specified and classifiable
Fire/flame
Unspecified
Mechanism of Injury
Num
ber o
f Day
s
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Median ICU Days by Injury Severity ScoreFigure
28
Median ICU Days by Injury Severity Score
01234567
1–8 9–15 16–24 >24
Injury Severity Score
Num
ber o
f Day
s
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by ED Discharge DispositionFigure
29
Incidents by ED Discharge Disposition
0.005.00
10.0015.0020.0025.0030.0035.0040.00
Died Floor bed (general admission, non specialty unit bed)
Home with services
Home without services
Intensive Care Unit (ICU)
Left against medical advice
Observation unit (unit that provides < 24 hour stays)
Operating Room
Other (j ail, institutional care facility, mental health, etc)
Telemetry/ step–down unit
Transferred to another hospital
NK/ NR
ED Discharge Disposition
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Reasons for Death in EDFigure
30
Reasons for Death in ED
-100200300400500600700800
DOA: Declared dead onarrival with minimal or
no resuscitation
Death after failedresuscitation attempt(no response within 15
minutes)
Died in ED (other thanfailed resuscitation
attempt)
Num
ber
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by Hospital Discharge DispositionFigure
31
Incidents by Hospital Discharge Disposition
0.0010.0020.0030.0040.0050.0060.0070.0080.0090.00
Discharge/ Transferred to home under care of Home...
Discharged home with no home services
Discharged/ Transferred to Skilled Nursing Facility
Discharged/ Transferred to an Intermediate Care Fac...
Discharged/ Transferred to another acute care hospi...
Discharged/ Transferred to another type of rehabilit...
Discharged/ Transferred to hospice care
ExpiredLeft against medical advice
Not Applicable
NK/ NR
Hospital Discharge Disposition
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by Hospital ComplicationsFigure
32
Incidents by Hospital Complications
0.00
0.20
0.40
0.60
0.80
1.00
1.20
Pneumonia
Acute respiratory distress syndrome (ARDS)
Deep vein thrombosis (DVT) / thrombophlebitis
Acute renal failure
Systemic sepsis
Cardiac arrest with CPR
Coagulopathy
Decubitus ulcer
Drug or alcohol withdrawal syndrome
Pulmonary embolism
Complications
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Incidents by RegionFigure
33
Incidents by Region
0.005.00
10.0015.0020.0025.0030.0035.0040.00
Midwest Northeast South West
Region
Perc
ent
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Case Fatality Rate by RegionFigure
34
Case Fatality Rate by Region
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
Midwest Northeast South West
Region
Case
Fat
ality
Rat
e (%
)
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Mechanism of Injury by RegionFigure
35
Mechanism of Injury by Region
0.00
10.00
20.00
30.00
40.00
Motor VehicleTraffic
Fall Struck by,against
Transport,other
Mechanism of Injury
Perc
ent
Midwest Northeast South West
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Injury Severity Score by RegionFigure
35
Injury Severity Score by Region
0.0010.0020.0030.0040.0050.0060.0070.00
1–8 9–15 16–24 >24
Injury Severity Score
Perc
ent
Midwest Northeast South West
NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide
Resources
• www.ntdb.org for more information about NTDB
• www.ntdbdatacenter.com to transmit data to NTDB
• www.ntdsdictionary.org for information on the new data standard