1. EVALUATION OF WISCONSIN STATE TRAUMA REGISTRY DATA LAURA D. CASSIDY, MS, PHD E. BROOKE LERNER, PHD MELISSA CHRISTENSEN AUGUST 8, 2012 2008-2011

2. 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

3. 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

4. Patient Data: % Complete

5. Injury location (city, county, zip) Opportunities for Improvement from 2008-2009 Report

6. Injury Data: % Complete

7. ED: GCS Opportunities for Improvement from 2008-2009 Report

8. ED Data: % Complete

9. Primary Diagnosis (ICD9 AIS, ISS) Opportunities for Improvement from 2008-2009 Report

10. Diagnosis Data: %Complete

11. Opportunities for Improvement from 2008-2009 Report ICU Days and Hospital Days (calculated variables?)

12. Outcomes: % Complete Autopsy & Organ donation denominator = discharged deceased, 2008=609, 2009 =580, 2010 =421, 2011=369

13. Data Quality Summary & Recommendations

14. 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

15. 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

16. Performance Improvement

17.  Use of the Statewide database  Develop goals as a group Standardize performance measurements Identify state-wide initiatives  Benchmarking

18. 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

19. 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

20. 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 2008200920102011 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%

21. 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% 2008200920102011 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%

22. 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 >20 200873%31% 200975%31% 201075%33% 201181%33%

23. Survival by Scene Time 0-20 minutes>20 minutes 201096% 201196% 2011 - 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

24. 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

25. 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 201094%97% 201194%97% Survival by time to transfer

26. ISS by mortality ISS Score20102011 1-151% 16-259%7% 26-7525%

27. Discussion