evaluation of wisconsin state trauma registry data laura d. cassidy, ms, phd e. brooke lerner, phd...

EVALUATION OF WISCONSIN STATE TRAUMA REGISTRY DATA

LAURA D. CASSIDY, MS, PHDE. BROOKE LERNER, PHDMELISSA CHRISTENSEN

AUGUST 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

Patient Data: % Complete

Race

Patient Account Number

Medical Record Number

Arrival Time

Date of Birth

Home Zip Code

Gender

Facility ID

State Trauma Number

Arrival Date

0.0 20.0 40.0 60.0 80.0 100.0

2011201020092008

• Injury location (city, county, zip)

Opportunities for Improvement from 2008-2009 Report

Injury Data: % Complete

Protective/safety deviceSecondary E-code

Injury position in vehicleInjury Time

**Protective/safety device**Injury Zip

**Injury City**Injury County

**Injury address stateFacility Access (Initial location)

**Injury site E849.**Injury Date

Injury type**Primary E-code

**Work RelatedInter-facility Transfer

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.

0

2011201020092008

• ED: GCS

Opportunities for Improvement from 2008-2009 Report

ED Data: % Complete

**Drug Screens 1

**GCS Total

**GCS Verbal

Temperature units

**Discharge time

**URR

Post ed / Direct Admission Disposition

Paralytics

0.0 20.0 40.0 60.0 80.0100.0

2011201020092008

• Primary Diagnosis (ICD9 AIS, ISS)

Opportunities for Improvement from 2008-2009 Report

Diagnosis Data: %Complete

**TRISS

**First AIS Severity

**ISS

**First AIS body region

**First Predot

**First Diagnosis

0.0 20.0 40.0 60.0 80.0 100.0

2011201020092008

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

**Hospital days

**ICU days

Organ donation

Autopsy

Admitted to

**Discharge Time

**Discharge Date

Facility Disposition

**Discharge Status

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.

0

2011201020092008

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

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  2008 2009 2010 2011Left blank 32% 35% 26% 15%Marked Unknown or N/A 1% 1% 8% 15%Total GCS Documented 67% 64% 66% 70%

Of those with a GCS, the percent ≤8 7% 6% 6% 6%

ED GCS Documentation

Documentation in registry improving Left blank only 11% in 2011

Data available to registry improvingGCS known increased from 63% to 76%

Severity appears constant or maybe decreasing from 7% to 5%

  2008 2009 2010 2011Left blank 35% 33% 24% 11%Marked Unknown or N/A 2% 2% 5% 12%Total GCS Documented 63% 65% 70% 76%Of those with a GCS, the percent ≤ 8 7% 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

CalculatedScene time

>202008 73% 31%2009 75% 31%2010 75% 33%2011 81% 33%

0 to 9 minutes

10 to 19 minutes

20 to 29 minutes

Greater than 30 minutes

0%

10%

20%

30%

40%

50%

60%

2008200920102011

Survival by Scene Time

  0-20 minutes >20 minutes2010 96% 96%2011 96% 96%

2011 - ISS>15 84% 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 less More than 3 hours2010 94% 97%2011 94% 97%

Survival by time to transfer

ISS by mortality

ISS Score 2010 20111-15 1% 1%16-25 9% 7%26-75 25% 25%

Discussion