EVALUATION OF WISCONSIN STATE TRAUMA REGISTRY DATA LAURA D. CASSIDY, MS, PHD E. BROOKE LERNER, PHD MELISSA CHRISTENSEN AUGUST 8,
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
Patient Data: % Complete
Injury location (city, county, zip) Opportunities for Improvement from Report
Injury Data: % Complete
ED: GCS Opportunities for Improvement from Report
ED Data: % Complete
Primary Diagnosis (ICD9 AIS, ISS) Opportunities for Improvement from Report
Diagnosis Data: %Complete
Opportunities for Improvement from Report ICU Days and Hospital Days (calculated variables?)
Outcomes: % Complete Autopsy & Organ donation denominator = discharged deceased, 2008=609, 2009 =580, 2010 =421, 2011=369
Data Quality Summary & Recommendations
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 Left blank 32%35%26%15% Marked Unknown or N/A 1% 8%15% Total GCS Documented 67%64%66%70% Of those with a GCS, the percent ≤8 7%6%
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% Left blank 35%33%24%11% Marked Unknown or N/A 2% 5%12% Total GCS Documented 63%65%70%76% Of those with a GCS, the percent ≤ 8 7% 6%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%) Times could be Calculated Scene time > %31% %31% %33% %33%
Survival by Scene Time 0-20 minutes>20 minutes % % ISS>1584%86% 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 3 hours or lessMore than 3 hours %97% %97% Survival by time to transfer
ISS by mortality ISS Score % %7% %
Discussion