1. Data Quality: Case ascertainment & Accreditation The Trauma Audit & Research Network (TARN)

2. Case ascertainment % (quantity)
Measure of Expected v Submitted number of cases per Hospital
Expected no. of cases derived from 2015 & Q HES/PEDW source data
HES: Hospital Episode Statistics (UK Government database)
PEDW: Patient Episode Database Wales
Source data: ICD10 codes assigned by Trusts’ Clinical coding teams
TARN inclusion criteria applied to source data: expected no. of cases derived>>>>

3. Inclusion Criteria
1) All Trauma patients who fulfill the following criteria:-
2) Admission > 3 days or
Admission to an intensive care area or
Transferred out for continuing care (>3 days total) or
Transferred in for continuing care (>3 days total) or
Died
When deciding whether or not to include a patient in TARN. All 3 criteria must be met.
Trauma patient
LoS
And Injuries
3) And whose injuries are TARN eligible

4. Inclusion Criteria: common inclusions/exclusions
Include (in isolation)
Exclude (in isolation)
Brain injury or skull fracture
Skin injuries
Unstable facial fracture
Stable facial fracture
Spinal fracture &/or cord injury
Spinal strains
Any internal Thoracic injury
Isolated Hip fractures 65+
(Neck of Femur fracture or single pubic rami)
Any internal Abdominal injury
Closed unilateral upper Limb fractures
Femur fractures (except 65+ isolated hip #)
Closed unilateral lower leg fractures
Pelvic fractures (except 65+ isolated hip #))
Any injury to fingers &/or toes
Open upper limb fracture
Burns treated in burns unit
Open lower leg fracture
Crush to long bones
Traumatic amputation to long bones
Hanging, Drowning or Strangulation
Blood loss >20%
Common inclusions and exclusions – in isolation.
Once one injury is included – all injuries should be included on the submission.

5. Case ascertainment % (quantity)
Measure of Expected v Submitted number of cases per Hospital
Expected no. of cases (denominator) compared to no. submitted cases per annum (numerator)
Case ascertainment % calculated for each hospital & Trust
Shown on Website, Clinical Reports & Dashboards
Updated every 4 months
Quarterly for Dashboards

6. Case ascertainment % (quantity)
Measure of Expected v Submitted number of cases per Hospital
Shown by default as 15% range, based on expected variation between source & TARN data
Shown as exact figure, once denominator has been validated (more later)
Case ascertainment used to validate published results

7. Case ascertainment RANGE calculation
Expected submissions: DENOMINATOR
100
Submissions: NUMERATOR 70
Case ascertainment range
70-82%

8. Improving Case ascertainment
HES v TARN comparison exercise produced each year
Updated when latest HES data is received
Comparison based on matching NHS numbers in each dataset
3 months’ data (July, October 2015 & Feb 2016) used as a representative sample

9. Case ascertainment validation exercise
Green cases: In both TARN & HES datasets: complete
Black cases: In HES dataset only: incomplete
Hospitals to review only the missing ‘black’ cases

10. Improving case ascertainment in 2 ways
Feedback list of ineligible cases to TARN
Cases removed: Denominator reduced
Identify missing groups of patients
Include going forward: Numerator increased
Case ascertainment then shown as exact (validated) figure at next update
HES exercise under Audit tab on TARN website

11. Results from previous years
REDUCTING DENOMINATOR: Common reasons for removal of cases
Rehabilitation only admissions
Old injuries
Incorrect ICD10 coding
Non-traumatic injuries
 INCREASING NUMERATOR: Commonly missed patient groups
Non isolated 65+ Hip fractures
Elderly SDH/SAH admitted to medical wards
Spinal fractures
LOS of exactly 3 day 

12. CURRENT ACCREDITATION FIELDS
Data Accreditation %
Measure of frequency of CORE data field completion
CURRENT ACCREDITATION FIELDS
Glasgow Coma Score or Intubation/ventilation
(Recorded Pre hospital, ED or first GCS – All cases)
Incident or 999 Date/time
Arrival time
Transfer reason, previous/next hospital, request date
CT time
Operation time, grade, speciality of surgeon, grade of anaesthetist
ED doctors: time, grade & speciality
Injury detail – proportion of NFS codes
*Pre-existing conditions
**Pupil reactivity for patients with AIS 3+ (Serious) head injuries
(Recorded in any location – including 1st hospital)
* Latest Probability of Survival (Ps)17 model
‘Other’ and ‘Not Known’ detrimental to Data Accreditation
** Future Probability of Survival model

13. Data Accreditation used to validate published results
Shown in:
Clinical report
Dashboards
Website

14. Questions?