Texas EMS/Trauma Registry System “Maven” NTDB 2014 Web Data Entry Training

“Maven” NTDB 2014 Web Data Entry Training Kayode C. Olupinyo Dept. of State Health Services (DSHS) Texas EMS/Trauma Registry (512) 458-7111 ext. 6224 kayode.olupinyo@dshs.state.tx.us

Training Objectives The National Trauma Data System Objectives New Data elements in the 2014 NTDB data set Why these elements are important New Texas Custom Questions How to do the Web Data Entry for the new data elements

National Trauma Data System

NTDB Implementation in Texas Texas EMS/Trauma Registry System (Maven) will fully adopt the NTDB Data Standard by January 2014 What is the implication for you: Uniformity in the National Data Standard Start to see the NTDB style questions when entering your report Start to see some additions to the questions in our Texas EMS/Trauma Registry System (Maven) Answer new Texas Custom Questions recommended by the Registry Solution Work Group (RSWG) Ability to extract NTDB data elements from the Texas EMS/Trauma Registry System and submit the National file to the NTDB Texas wants to adopt the NTDB data set in order to create uniformity. For those of you who already have your individual software(s), your vendors may by now probably in the process of updating your software to reflect the new NTDB questions.

NTDB Objectives The National Trauma Data Bank (NTDB) is the largest aggregation of US Trauma Registry data ever assembled. NTDB collects trauma registry data from participating trauma centers on an annual basis. Data are aggregated and used to produce: Annual Reports Hospital Benchmark Reports Data Quality Reports The goal of the NTDB is to inform the medical community, the public, and decision makers about a wide variety of issues that characterize the current state of care for injured persons. Presently, TX is represented in NTDB by level 1 and 2 trauma centers. We hope to increase the level of reporting by all hospitals and trauma centers. This will help to increase the level of comparison of Texas to other states in terms of the injury burden and other parameters.

What about Texas…… Will adopt the NDTB 2014 Data Dictionary The Data Dictionary for the new Texas Custom Questions will be available January 2014 on our webpage: http://www.dshs.state.tx.us/injury/registry/datadict.shtm The link to the NTDB 2014 Data Dictionary is: http://www.ntdsdictionary.org/dataElements/datasetDictionary.html

Five New NTDB Elements

Injury Information Section 3 New Questions

1. Report of Physical Abuse Definition: A report of suspected physical abuse was made to law enforcement and/or protective services. Field Values: 1. Yes 2. No Additional Information: This includes, but is not limited to, a report of child, elder, spouse or intimate partner physical abuse. You cannot put “Not Applicable“ in this field. Data Source Hierarchy: 1. EMS Run Sheet 2. ED Records 3. H and P(History and Physical) 4. Nursing Notes 5. Case Manager/Social Services’ Notes 6. Physician Discharge Summary http://www.bbc.co.uk/news/education-21714645 basically abuse is under-reported and by asking these questions there is hope children and elderly will be identified sooner and intervention taken. Parents who abuse children take them to different facilities so they don’t get caught – so we can use data to look at patterns of children who have been injured multiple times.

2. Investigation of Physical Abuse Definition: An investigation by law enforcement and/or protective services was initiated because of the suspected physical abuse. Field Values: 1. Yes 2. No Please Note Additional Information: You can only complete this if your answer to “Report of Physical Abuse” is “Yes” Use the Null Value “Not Applicable where the “Report of Physical Abuse” is “No” Data Source Hierarchy: 1. EMS Run Sheet 2. ED Records 3. H and P(History and Physical) 4. Nursing Notes 5. Case Manager/Social Worker’s Note 6. Physician Discharge Summary

3. Caregiver At Discharge Definition: The patient was discharged to a caregiver different than the caregiver at admission due to suspected physical abuse. Field Values: 1. Yes 2. No Additional Information: Only complete when “Report of Physical Abuse” is “Yes” Only complete for minors as determined by state/local definition, excluding emancipated minors. Use the Null Value “Not Applicable where the “Report of Physical Abuse” is “No” Data Source Hierarchy: 1. Case Manager/Social Services’ Notes 2. Physician Discharge Summary 3. Nursing Notes 4. Progress Notes Was the patient released to a different caregiver?

Pre-hospital Information Section 2 New Questions

1. Trauma Center Criteria Definition: Physiologic and anatomic EMS trauma triage criteria for transport to a trauma center Field Values: These values are as defined by the Centers for Disease Control and Prevention and the American College of Surgeons Committee on Trauma. The link to this triage criteria is: http://www.cdc.gov/mmwr/pdf/rr/rr6101.pdf - pages 4-10 Additional Information: The Null Value "Not Applicable" should be used if EMS Run Sheet indicates patient did not meet any Trauma Center Criteria. The Null Value "Not Known/Not Recorded" should be used if this information is not indicated on the EMS Run Sheet or if the EMS Run Sheet is not available. Data Source Hierarchy: 1.EMS Run Sheet Glasgow Coma Score < 14 Systolic blood pressure < 90 mmHg Respiratory rate <10 or > 29 breaths per minute (<20 in infants aged <1 year) or need for ventilatory support All penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee Chest wall instability or deformity (e.g., flail chest) Two or more proximal long-bone fractures Crushed, degloved, mangled, or pulseless Amputation proximal to wrist or ankle Pelvic fracture Open or depressed skull fracture Paralysis

Trauma Center Criteria Field Values 1. Glasgow Coma Score < 14 2. Systolic blood pressure < 90 mmHg 3. Respiratory rate < 10 or > 29 breaths per minute (< 20 in infants aged < 1 year) or need for ventilatory support 4. All penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee. 5. Chest wall instability or deformity (e.g., flail chest) 6. Two or more proximal long-bone fractures 7. Crushed, degloved, mangled, or pulseless extremity. 8. Amputation proximal to wrist or ankle 9. Pelvic fracture 10. Open or depressed skull fracture 11. Paralysis  

2. Vehicular, Pedestrian, Other Risk Injury Definition: Physiologic and anatomic EMS trauma triage criteria for transport to a trauma center Field Values: These values are as defined by the as defined by the Centers for Disease Control and Prevention and the American College of Surgeons Committee on Trauma. Additional Information: The Null Value "Not Applicable" should be used if EMS Run Sheet indicates patient did not meet any Trauma Center Criteria. The Null Value "Not Known/Not Recorded" should be used if this information is not indicated on the EMS Run Sheet or if the EMS Run Sheet is not available. Data Source Hierarchy: 1.EMS Run Sheet

Vehicular, Pedestrian, Other Risk Injury Field Values 1. Fall adults: > 20 ft. (one story is equal to 10 ft.) 2. Fall children: > 10 ft. or 2-3 times the height of the Child 3. Crash intrusion, including roof: > 12 in. occupant site; > 18 in. any site 4. Crash ejection (partial or complete) from vehicle 5. Crash death in same passenger compartment 6. Crash vehicle telemetry data (AACN) consistent with high risk injury 7. Auto versus. pedestrian/bicyclist thrown, run over, or > 20 MPH impact 8. Motorcycle crash > 20 mph

New Texas Custom Questions

Pre-hospital Information Section 4 New Questions

New Texas Custom Questions Arrived at Transferring Hospital Date Arrived at Transferring Hospital Date Null Values Arrived at Transferring Hospital Time Arrived at Transferring Hospital Time Null Values Left Transferring Hospital Date Left Transferring Hospital Date Null Values Left Transferring Hospital Time Left Transferring Hospital Time Null Values These questions are under the section Pre-hospital Information

These set of questions will only appear if.. Your answer to the question “Was this patient transferred to your facility?” is YES (If your answer is NO, these questions will not appear.)

Arrived at Transferring Hospital Date and Time This is collected if the patient was transferred from another facility to your facility, which is now the second one. We want more information about how long the patient stayed in the first facility before being transferred to the second one. This is important because transfers are usually done so the patient can receive care at a higher trauma level designated facility that is more suitable to the severity of the injury.

Left Transferring Hospital Date and Time This is collected if the patient was transferred from another facility to your facility, which is now the second one. We want more information about how long the patient stayed in the first facility before being transferred to the second one. This is important because transfers are usually done so the patient can receive care at a higher trauma level designated facility that is more suitable to the severity of the injury.

Web Data Entry Demonstration

Demonstration Patient John Maven is going to be our patient today. He is a 70 year old male who fell from the step on Nov.1,2013. His son called 911. He had multiple comminuted fracture of the humerus, proximal radius and ulna with flail chest. 911 call was made and EMS was dispatched to the scene of this event and he was transferred to University Medical Center (Level 4) where he was admitted for 1 day. He was subsequently transferred to Maven Hospital trauma unit (Level 1) for a higher level of care and on physical assessment, the nurse noticed some pin-point erythematous area that looks like cigarette burn areas on his back and suspected physical abuse.

References CDC – Guidelines for Field Triage of Injured Patients: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6101a1.htm DSHS – Hospital Web Data Entry Training: http://www.dshs.state.tx.us/injury/registry/Training.shtm NTDB – What is the NTDB National Trauma Data Standard? http://www.ntdsdictionary.org/theNTDS/whatIsNTDS.html

Questions?