EVALUATION OF WISCONSIN STATE TRAUMA REGISTRY DATA LAURA D. CASSIDY, MS, PHD E. BROOKE LERNER, PHD...
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Transcript of EVALUATION OF WISCONSIN STATE TRAUMA REGISTRY DATA LAURA D. CASSIDY, MS, PHD E. BROOKE LERNER, PHD...
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EVALUATION OF WISCONSIN STATE TRAUMA REGISTRY DATA
LAURA D. CASSIDY, MS, PHDE. BROOKE LERNER, PHDMELISSA CHRISTENSEN
AUGUST 8, 2012
2008-2011
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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
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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
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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
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• Injury location (city, county, zip)
Opportunities for Improvement from 2008-2009 Report
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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
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• ED: GCS
Opportunities for Improvement from 2008-2009 Report
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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
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• Primary Diagnosis (ICD9 AIS, ISS)
Opportunities for Improvement from 2008-2009 Report
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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
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Opportunities for Improvement from 2008-2009 Report
• ICU Days and Hospital Days (calculated variables?)
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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
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Data Quality
Summary & Recommendations
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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
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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
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Performance Improvement
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Performance Improvement
Use of the Statewide database Develop goals as a group
Standardize performance measurements Identify state-wide initiatives
Benchmarking
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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
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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
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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%
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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%
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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
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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
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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
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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
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ISS by mortality
ISS Score 2010 20111-15 1% 1%16-25 9% 7%26-75 25% 25%
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