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Evaluation of Wisconsin state trauma registry dataLaura D. Cassidy, Ms, PhdE. Brooke lerner, PhdMelissa ChristensenAugust 8, 2012 2008-2011
Importance of High Quality Trauma Registry Data & Analysis • Reduce the burden of injury • Improve the quality of care of injured patients • Resource utilization • Provide state and regional data for maximum effectiveness in dissemination However, if data are not complete and accurate, bias may exist and erroneous conclusions may be drawn
Objective1 Task :1 Evaluate the data currently housed in the state trauma registry for completeness and accuracy with focus on the National Trauma Data Standard (NTDS) Deliverables: • Reports of frequency distribution and descriptive statistics for the 2008 through 2011 data sets • Results of the comparisons and listings of variables identified as opportunities for improvement in last report
Opportunities for Improvement from 2008-2009 Report Injury location (city, county, zip)
Opportunities for Improvement from 2008-2009 Report Primary Diagnosis (ICD9 AIS, ISS)
Opportunities for Improvement from 2008-2009 Report • ICU Days and Hospital Days (calculated variables?)
Outcomes: % Complete Autopsy & Organ donation denominator = discharged deceased, 2008=609, 2009 =580, 2010 =421, 2011=369
Summary & Recommendations Data Quality
Standardization • Overall improvements on the areas identified • Data Dictionary and Coding needs to be updated • City fields contain street names • Counties contain numbers and text • Mixing text and numeric fields • Missing values • Some coded unk, 9999 or blank • Makes data analysis more complicated and less reliable
Specific Example • Inconsistency with coding deaths • The discharge destination = morgue more deaths than the variable discharged deceased • Facility disposition did not match the dictionary • 1= morgue in dictionary but appears to be discharged alive in data
Performance Improvement • Use of the Statewide database • Develop goals as a group • Standardize performance measurements • Identify state-wide initiatives • Benchmarking
Performance Improvement • Current PI indicators • EMS scene time >20 minutes • Completed prehospital patient record provided or available to the trauma care facility within 48 hours • A Glasgow Coma Scale (GCS) < or equal to 8 and no definitive (protected) airway for EMS and hospitals • The time at the referring trauma care facility exceeds 3 hours exclusive of the transport time • Use of the regional triage and transport guidelines
Sub-Committee Suggestions • Rate of documenting GCS EMS and ED • Scene time greater than 20 minutes • Evaluate mortality for those over 20 minutes • Rate of prehospital patient record turned in (removing 48 hour criteria) • Time to transfer >3 hours • Evaluate mortality for those with >3 hours • ISS by mortality • Age by mechanism, ISS and mortality
EMS GCS Documentation • Documentation in registry improving • Left blank only 15% in 2011 • Appears data not available from the field in many cases • GCS only known for between 64 and 70% • Severity appears constant with about 6% GCS 8 or less
ED GCS Documentation • Documentation in registry improving • Left blank only 11% in 2011 • Data available to registry improving • GCS known increased from 63% to 76% • Severity appears constant or maybe decreasing from 7% to 5%
EMS scene time >20 minutes • Compared time arrived at scene to time left scene • Removed negative times and >120 min (~20 cases per year) • Improved documentation (73% complete to 81%) • No change to negative change in compliance (31% to 33%)
Survival by Scene Time • Compared survival by scene time • Found no difference • May need to control for severity or other confounders • ISS is likely not sufficient
Run Report • Completed pre-hospital patient record provided • 2008: 84% • 2009: 80% • 2010: 80% • 2011: 86% • Denominator primary EMS transport mode ambulance, helicopter, or water ambulance • No missing data – no may be default
Time at referring facility exceeds 3 hour • 2008: 34% were > 3 hours • 2009: 32% • 2010: 33% • 2011: 32% • Survival difference opposite of expected likely need to control for confounders Survival by time to transfer