national trauma data standard: everything you’ve wanted to know but have been afraid to ask! n....
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National Trauma Data Standard: National Trauma Data Standard: Everything you’ve wanted to know Everything you’ve wanted to know
but have been afraid to ask!but have been afraid to ask!
N. Clay Mann, PhD, MSN. Clay Mann, PhD, MS
ObjectivesObjectives
• 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 RegistryNeed 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 RegistriesStates with Statewide Registries
Submission to stateNo
YesPlanning – CA, DC, ID, KY, LA, ME, MA, MI, NE, NM, TN, WV, WI
No Plans – HI, IN, NH, NJ, RI, VT
Technical Difficulties – ND, SD
States with RegistriesStates 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 AcquisitionVariation in Case Acquisition
Threats to Data IntegrityThreats to Data Integrity
• Mandatory/elective Submission– Completeness of Case Capture
• Difference in Case Definition
• Difference in Coding Conventions
Are Registries Comparable?Are Registries Comparable?
Variability in Case DefinitionVariability in Case Definition
Inclusion Criteria Number Exclusion Criteria
Number
Abuse 4 Abuse 3Blisters, 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
Variability in Case DefinitionVariability 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 (ICD-9 808.2)
– 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 ConventionsVariability in Coding Conventions
• 15 states………..……initial GCS
• 8 states……..initial and last GCS
• 1 state………………...worst GCS
• 1 state………………… best GCS
• 1 state……..initial and worst GCS
Glasgow Coma Score in ED
Variability in Coding ConventionsVariability in Coding Conventions
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 (< 1 hour, 1-6 hours,
7-12 hours, 13-24 hours, or >24 hours) 1
Time of Injury
Data Needs for RegistriesData 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
Existing National RegistryExisting National Registry
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 StandardNational Trauma Data Standard
2.2
The “Bank” The “Currency”The “Bank” The “Currency”
Standard Inclusion Criteria Standard Data Definitions Standard Source Hierarchy Standard Comorbidities
Pediatric specific additions
Auto-Calculated Fields Edit Checks
The “ Validator”
National Trauma Data StandardNational Trauma Data Standard
Ensuring Common VariablesEnsuring Common Variables
• Common Subset of Variables– Evaluate variable frequency across registries– Consider importance at national level– Seek consensus from experts
Variable SchemaVariable Schema
Calculated field
Calculated field
Calculated field
Injury Information
Injury Date/Time
Work RelatedPatient's Occupational Industry
Patient's Occupation
Primary E-Code
Secondary E-Code
Additional E-Code
Incident Location ZipIncident State
Incident County
Incident City
Protective DevicesChild Specific Restraint
Airbag Deployment
Trauma Type (blunt, penetrating, burn)
Injury Intentionality (using CDC matrix)
FIPS code-location code
Primary Variable
Supportive Variable
Autogenerated Variable
Secondary Variable
Auto-generated VariablesAuto-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
Choosing Inclusion CriteriaChoosing Inclusion Criteria
Uniform Inclusion Criteria– Collect all state inclusion/exclusion criteria– Assess criteria for commonalities– Look for least common denominator?
Sta
tes
Criterion
NTDS Inclusion Criteria
Improving Data QualityImproving Data Quality
NTDS Edit ChecksNTDS Edit Checks
Development of the ValidatorDevelopment of the Validator
National Trauma Data StandardNational Trauma Data StandardTHE “VALIDATOR”
““Hasta La Vista Bad Data”Hasta La Vista Bad Data”
Patient Care Report Software
Agency C’s Software
911Center
Patient Care
Report
Agency A’s Software
Patient Care
Report
Patient Care
Report
Agency B’s Software
Benefit of a Common Benefit of a Common XMLXML
NTDBNTDB NEMSISNEMSIS
External Server
Outcomes
NTDSNTDS
“Validator”
“Validator”
Improving Data UsabilityImproving Data Usability
On Line Data SubmissionOn Line Data Submission
Facility DemographicsFacility 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
Verification RequirementVerification 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 SubmissionData Submission
Call for DataCall 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!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!
Tasks Seem Overwhelming?
Technical AssistanceTechnical Assistance
• Visit the website– Join the NTDS Google Group
• Talk with your software vendors
• Utilize resources at the ACS and NEMSIS TAC
Join the NTDS Google Group!
For More Information…For More Information…
• www.ntdb.org
• www.ntdsdictionary.org
• www.ntdbdatacenter.com
Additional Questions
• Contact– N. Clay Mann
(801) 585-9161
– Melanie Neal
(312) 202-5536
How do we get here from there?How do we get here from there?
Questions