Trauma Registry
Mazen S. Zenati, M.D. MPH, PH.D.
University of Pittsburgh
Department of Surgery and
Epidemiology
What Is a Trauma Registry?
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A computerized data base
that consist of extensive
demographic, injury
information, and trauma
outcome
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Includes all trauma patient
data from scene to hospital
discharge
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Many uses, many users
Trauma Registry
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A trauma registry is a system of timely data
collection that aids in the evaluation of trauma
care for a set of injured patients who meet
specific criteria for inclusion. In addition to
hospital-based trauma data, it also includes
patient information from other health care
providers including pre-hospital care and
rehabilitation if utilized.
Provides a mechanism for overall patient care and
system evaluation.
Trauma Registry
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Relay on Commercial Software:
Collector®, TraumaBase®, Trauma 1®,
NTRACS®.
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Used by most trauma centers in U.S.
Designed by Tri-Analytics, based on:
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The ABBREVIATED INJURY SCALE (AIS) which is an anatomical
scoring system in which injury are ranked on a scale of 1 to 6, with
a being minor, 5 severe, and 6 an un-survivable
The INTERNATIONAL CLASSIFICATION of DISEASES (ICD-9)
which is used to provide a standard classification of diseases for
the purpose of health records and to classify diseases and to track
mortality rates based on death certificates and other vital health
records.
What Does a Trauma Registry
Do?
Provides for the:
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Collection
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Storage
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Reporting
of trauma patient data
Trauma Registry Functions
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Trauma case identification, abstraction
Trauma quality improvement
Data sets for research and outcome studies
Reporting: Standard reports, quarterly reports
to State registry
Trauma report for projecting and strategic
planning: Billing, transfer center, ad hoc
reports
State trauma designation
Trauma Case Abstraction:
Collector
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Trauma patient information from:
Power chart notes and other
electronic data sources
Emergency Department (ED),
Operating Room (OR) radiology
reports and discharge summary
Entered directly into Collector
data base
Data Collection
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Certain parts are concurrent and many retrospective
in nature
Concurrent for front ended data and retrospective
for back ended data
Identifying patients based on trauma lists, ICD-9 of
admission and diagnosis and used to obtain
concurrent data
Medical records are the main source for
retrospective data collection
Data collected on concurrent bases can be used in
identifying patients for quality assurance projects
and clinical trial.
Record Manager to add, edit,
view and search
Data that need to be entered
Looking for individual record
Trauma Registry Functions:
Quality Improvement
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Quality improvement looks at:
Patients
Providers
Processes
Outcomes
A Model for Trauma Registry Quality Improvement
Collector Registry Software
• Free to all hospitals
•Built-In Logic Checks
• Logger Submission Tool
• Error Reports
Internal Analysis
• Record linking
• Comparative Reports
• Data quality indicators
Outcomes
TAC
Training
•Data Entry & Submission
• Report Writing
• Registry Users Manual
• AIS Injury Scoring Course
Technical Assistance
• On-site consultation
• Toll-free support
Trauma Registry
Quality Improvement
Trauma Registry Data
Validation during
Designation Reviews
Trauma
Registrars
Networks
Trauma Registry :
Quality Improvement
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Individual and aggregate cases
Many trauma quality indicators reviewed by
an interdisciplinary committee
Indicators (audit filters) divided into
categories by patient age, area of care,
complications
Trauma Quality Audit Filters-- Pre-hospital:
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No Emergency Medical Services (EMS) run report
in chart
Scene time > 20 minutes
Cricothyroidotomy in field
Trauma Registry :
Quality Improvement
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Trauma Audit Filters-- Emergency Department:
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Difficult intubation
No CAT scan within 2 hours if head injury
ED stay > 2 hours with BP <90, admit to OR
Admitted, readmitted within 72 hours
Trauma Team not activated
Delay in attending/service response
Length of ED stay > 6 hours
ISS > 14 (medium to serious injury) admitted to nonsurgical service
Trauma Registry :
Quality Improvement
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Trauma Audit filters-- Complications:
 Decubitus ulcer
 Deep vein thrombosis
 Pulmonary Embolus
Trauma Audit Filters—Process:
 Laparotomy needed, not done within 4 hr
 Non-surgical treatment of:
 Gunshot wound to abdomen
 Adult femoral shaft fracture
 Open long bone fractures, no operative treatment within 8 hours
 Epidural and subdural hematoma, first craniotomy > 4 hours
after arrival
Trauma audit filters—Deaths:
 All trauma deaths
 Unexpected deaths (ISS < 15)
 Unexpected survivors (ISS > 50)
Trauma Registry:
Quality Improvement
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Trauma audit filters– Pediatric:
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Transfers to Children’s Hospital for continued
care—review length of stay, outcomes
(excludes rehab transfers)
Diagnostic peritoneal lavage in child < 12
years of age
Negative laparotomy; or gastrostomy,
jejunostomy tube placement in patients < 15
years of age
ALL pediatric deaths
Trauma Registry: Reporting
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Standard reports: Run a SQL query against the
main data base
Convert result to Excel spreadsheet, MS word document
Standard reports:
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Abstract list, status report
Activity reports
Transfusion Practice Committee report
Annual trauma summary
Regional Quality Assurance summary
State Trauma Registry
Quarterly report
Requires complex manipulation of data in certain occasions
Trauma Registry: Reporting
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Standard reports—Collector:
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Billing reports—Uses ISS for state trauma fund
reimbursement
Transfer Center reports—ISS info to referring
facilities
Ad hoc reports:
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As requested, Trauma Registry info to support
quality improvement and research programs
Data released under HIPPA and IRB (Institutional
Review Board) guidelines
Query the registry and producing reports
Running a report
Trauma Registry
Who Do We Include?
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State criteria:
All patients with a discharge trauma diagnosis code
ICD-9 800-904, 910-959
Drowning, asphyxiation (hanging), electrocution
Activated the Trauma Resuscitation Team response
Deaths: on arrival, in hospital
Transfers: In or out, via EMS or ambulance
All pediatric trauma patients, age 0 to 14
All adult patients with length of stay > 48 hours
Foreign body diagnosis that causes injury (GSW)
ALL admits, even if < 48 hours
Trauma Registry:
What We Collect
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Demographics:
Name, hospital number, address, age
Date of birth, race, sex
Social Security number
Incident info:
Injury date/time
Primary, secondary E-codes (etiology, external cause of event)
Setting (street vs home)
Injury location (address)
E-codes: External cause, circumstances of injury
Very detailed—Falls:
From stairs, or steps, ladders, scaffolding, out of building, other
structure, into hole or other opening,
Trauma Registry:
What We Collect
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One level, same level, other, unspecified…….
Incident info, E-Codes very important for:
Research: What really causes injury?
Injury prevention: Intentional vs non-intentional
trauma and interventions
Incident info: (Yes, No, Unknown)
Occupant: Driver, passenger, unknown
Seat belt: Type (lap, shoulder)
Air Bag
Protective Device: (helmet, other)
Work Related
Trauma Registry:
What We Collect
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Incident info:
Injury note: Hand written explanation of any unusual factors relating to
traumatic event
Abuse, pregnant, missed diagnosis
Seen within 72 hours
Other Hospital:
Other facility transfer: Yes, No
Transfer from:
Other facility: admit date/time, patient number, alcohol level, toxicology
screen
Pre-hospital/field:
Transport mode: Air, ground, multiple methods
Times: Dispatch, scene arrival/departure, ED arrival
Pre-hospital/field:
Field vital signs: pulse, respiratory rate, blood pressure
Trauma Registry:
What We Collect
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Glasgow Coma Score: neuro status
Procedures: CPR, flutter valve, intubation, MAST pants
Emergency Department:
Admit date/time, disposition
Trauma Team Activation
Admit vital signs: pulse, respirations, blood pressure, Glasgow
coma score
Procedures: multiple!
Inpatient:
Inpatient admit date/time, service, unit, provider, disposition
Discharge: transfer, rehab, psych
Patient Outcome: Glasgow coma score, functional level
Diagnosis, procedures summary
Death: Organ/tissue donor status
Brain Death criteria
Trauma Registry:
Where Does the Data Go?
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Quarterly submission to State Trauma
Registry—300 to 400 data elements per
patient
Trauma Registry:
How Is The Data Used?
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Injury surveillance, analysis, prevention programs
Monitor, evaluate major trauma patient outcomes
Compliance with state standards
Resource planning, system design and
management
Research and education
State-wide and regional quality assurance, system
evaluation
Trauma Registry:
Impact On Trauma Care
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Identifies injury cause: What is really hurting people?
Provides “counts:” Spike in injury type
Intentional vs. unintentional: GSW: suicide, homicide,
or “accidental”
Identifies cases for research, quality assurance
Data drives legislation: Motorcycle helmet, seatbelt
laws
Design, evaluate injury prevention programs
Evidence based trauma care practice
Injury severity scores/financial issues
—State trauma fund
Trauma Registry:
Impact On Trauma Care
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Concurrent review of complications:
preventable/non-preventable
Case distribution: Facial fractures
Facility improvements: More operating rooms, ED
CAT scanner
Blood usage
Answers the questions:
Who is getting hurt and how?
What really works for treatment, prevention?
How much does it all cost?
How, where can we improve?
Trauma Registry:
Summary
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Lots of data
Lots of users
Lots of uses
Lots of work
Increasingly important for evaluating care,
systems, and prevention
Very useful tool for trauma research
Still under-utilized and need to be more
readily accessible for research