NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide...

NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide

National Trauma Data Bank 2008Annual Report

Version 8.0


NTDB Annual Report 2008

EditorsAvery B. Nathens, MD, FACS, Chair Richard J. Fantus, MD, FACS, Chair

National Trauma Data Bank Subcommittee Trauma Registry Advisory Ad Hoc Committee

American College of Surgeons Committee on Trauma LeadershipJohn J. Fildes, MD, FACS J. Wayne Meredith, MD, FACS Chair,

Committee on Trauma Medical Director, Trauma OfficeDivision of Research and Optimal Patient Care

National Trauma Data Bank SubcommitteePalmer Q. Bessey, MD, FACS

Karen J. Brasel, MD, FACSDavid E. Clark, MD, FACSArthur Cooper, MD, FACS

Joseph Cuschieri, MD, FACSRichard J. Fantus, MD, FACS

Jeffrey S. Hammond, MD, FACSRichard J. Kagan, MD, FACS

Geoffrey R. Keyes, MD, FACSMichael D. McGonigal, MD, FACSFrederick H. Millham, MD, FACS

Allen F. Morey, MD, FACSCharles E. Morrow, Jr., MD, FACS

Michael L. Nance, MD, FACSAvery B. Nathens, MD, PhD, FACS

Manoj R. Shah, MD, FACSGlen H. Tinkoff, MD, FACS

N. Clay Mann, PhD, MS, Consultant

National Trauma Data Bank StaffMelanie Neal, Manager

Sandra Goble, StatisticianChrystal Price, Coordinator


AcknowledgmentsThe American College of Surgeons Committee on Trauma wishes to thank the Centers for Disease Control and Prevention (CDC) for their support of the NTDB.


Please note:The abbreviation NK/NR used on many tables denotes Not Known, Not Recorded, or Blank. If Not Applicable is not shown as a separate row on the table, then it is also included in the NK/NR category.

“Local ISS” denotes ISS scores submitted directly by hospitals regardless of the method of calculation. “ICD90 Derived” are scores derived by converting ICD9 codes to AIS using the ICD 90 Mapping program and then calculating ISS with the resulting AIS severity scores. “AIS Derived” are calculated from AIS submitted directly by hospitals. Analyses in this report use the ICD 90 Derived ISS.


Percent of hospitals = Number of hospitals in the state that have submitted to the NTDB divided by the number of hospitals identified by the Trauma Exchange Information Program (TIEP) as trauma centers designated by a state or local authority and/or verified by the American College of Surgeons.

States and U.S. Territories Submitting to the NTDB

67% or greater34% to 66%0% to 33%

Figure1


Facilities by Bed Size

Facilities by Bed Size

0

20

40

60

80

100

120

140

160

180

≤200 201 - 400 401 - 600 > 600

Bed Size Category

Num

ber

of F

acilit

ies

Figure2


Facilities by Trauma Level

Facilities by Trauma Level

0

20

40

60

80

100

120

140

160

180

I II III IV NA Other

Trauma Level

Num

ber

of F

acilit

ies

Figure3


Facilities by Region

Facilities by Region

0

20

40

60

80

100

120

140

160

Midwest Northeast South West

Regions

Num

ber

of F

acilit

ies

Figure4


Incidents by Age Figure

5A

Incidents by Age

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

Age

Num

ber

of C

ases


Case Fatality Rate by AgeFigure

5B

Case Fatality Rate by Age

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

Age

Cas

e F

atal

ity

Rat

e (%)


Incidents by Age and GenderFigure

6A

Incidents by Age and Gender

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

0 10 20 30 40 50 60 70 80 90 100

Age

Num

ber

of C

ases

Female Male Unknown


Case Fatality Rate by Age and Gender

Case Fatality Rate by Age and Gender

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

Age

Cas

e F

atal

ity

Rat

e (

%)

Case Fatality Rate - Female Case Fatality Rate - Male Case Fatality Rate - Unknown

Figure

6B


Alcohol UseFigure7

Alcohol Use

0.005.00

10.0015.0020.0025.0030.0035.0040.0045.00

No

(confirmed

by test)

No (not

suspected,

not tested)

Yes -

(confirmed

by test

beyond

legal limit)

Yes -

(confirmed

by test,

trace

levels)

Not

Applicable

*NK/ NR

Perc

ent


Drug UseFigure8

Drug Use

0.00

10.00

20.00

30.00

40.00

50.00

60.00

No

(confirmed

by test)

No (not

suspected,

not tested)

Yes

(confirmed

by test,

illegal use

drug)

Yes

(confirmed

by test,

prescription

drug)

Not

Applicable

NK/ NR

Perc

ent


Primary Payment SourceFigure9

Primary Payment Source

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

Blue Cross/Blue Shield

Medicaid

Medicare

No Fault Automobile

Not Billed (for any reason)

OtherOther Government

Private/ Commercial Insurance

Self Pay

Workers Compensation

Not Applicable

NK/ NR

Payor Source

Num

ber

of C

ases


Incidents by Mechanism of InjuryFigure

10A

Incidents by Mechanism of Injury

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

Motor Vehicle

Traffic

Fall Struck by,

against

Transport,

other

Firearm Cut/ pierce

Mechanism of Injury

Perc

ent


Case Fatality Rate by Mechanism of InjuryFigure

11B

Case Fatality Rate by Mechanism of Injury

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

18.00

Motor Vehicle

Traffic

Fall Struck by,

against

Transport,

other

Firearm Cut/ pierce

Mechanism of Injury

Cas

e F

atal

ity

Rat

e (%)


Mechanism of Injury by AgeFigure

11

Mechanism of Injury by Age

0

1,000

2,000

3,000

4,000

5,000

6,000

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

Age

Num

ber

of C

ases

MVT Fall Struck by, against Transport, other Firearm Cut/ pierce


Case Fatality Rate by Mechanism of Injury and AgeFigure

12

Case Fatality Rate by Mechanism of Injury and Age

0.00

20.00

40.00

60.00

80.00

100.00

120.00

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

Age

Cas

e F

atal

ity

Rat

e (%)

MVT Case Fatality Rate Fall Case Fatality Rate

Firearm Case Fatality Rate Transport, Other Case Fatality Rate

Struck by, against Case Fatality Rate Cut/ pierce Case Fatality Rate


Incidents by Mechanism of Injury and GenderFigure

13A

Incidents by Mechanism of Injury and Gender

0.005.00

10.0015.0020.0025.0030.0035.0040.0045.0050.00

Motor

Vehicle

Traffic

Fall Struck by,

against

Transport,

other

Firearm Cut/ pierce

Mechanism of Injury

Perc

ent

Female Male


Case Fatality Rate by Mechanism of Injury and Gender

Figure

13B

Case Fatality Rate by Mechanism of Injury and Gender

0.002.00

4.006.00

8.0010.00

12.0014.00

16.0018.00

Motor

Vehicle

Traffic

Fall Struck by,

against

Transport,

other

Firearm Cut/ pierce

Mechanism of Injury

Cas

e F

atal

ity

Rat

e (%)

Female Male


Incidents by Comparative Injury Severity ScoresFigure

14

Incidents by Comparative Injury Severity Scores

0.00

10.00

20.00

30.00

40.00

50.00

60.00

1-8 9-15 16-24 >24 Missing

Injury Severity Score

Perc

ent

Local ISS ICD-90 Derived AIS Derived


Case Fatality Rate by Injury Severity ScoreFigure

15

Case Fatality Rate by Injury Severity Score

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

1-8 9-15 16-24 >24 *NK/ NR

ISS Categories

Cas

e F

atal

ity

Rat

e (

%)


Incidents by Injury Severity Score and Age

Incidents by Injury Severity Score and Age

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

Age

Num

ber

of

Cas

es

1-8 9-15 16-24 >24 Missing

Figure

16


Case Fatality Rate by Injury Severity Score and AgeFigure

17

Case Fatality Rate by Injury Severity Score and Age

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

Age

Cas

e F

atal

ity

Rat

e (

%)

1-8 9-15 16-24 >24 NK/NR


Incidents by Work-Related InjuriesFigure

18A

Incidents by Work-Related Injuries

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

Yes No Not Applicable NK/ NR

Perc

ent


Case Fatality Rate by Work-Related InjuriesFigure

18B

Case Fatality Rate by Work-Related Injuries

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

Yes No Not Applicable NK/ NR

Cas

e F

atal

ity

Rat

e (%)


Case Fatality Rate by IntentFigure

19

Case Fatality Rate by Intent

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

18.00

20.00

Assault Self-inflicted Undetermined Unintentional Other NK/ NR

Intent

Cas

e F

atal

ity

Rat

e (%)


Case Fatality Rate by Location E-codeFigure

20

Case Fatality Rate by Location E-Code

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Location E-Code

Cas

e F

atal

ity

Rat

e (%)


Incidents by AIS Body Region

Note: An incident may involve multiple organ systems and a patient will then be counted in each of the organ systems in which there is an injury.

Figure

21

Incidents by AIS Body Region

020,00040,00060,00080,000

100,000120,000140,000160,000180,000200,000

AIS Body Region

Num

ber

of C

ases


Incidents with AIS ≥ 3 by AIS Body Region

Note: An incident may involve multiple body regions, and, if so, the patient will be counted in each of the categories in which there is an injury.

Figure

22

Incidents with AIS ≥ 3 by Body Region

0.005.00

10.0015.0020.0025.0030.0035.0040.0045.0050.00

Body Region

Perc

ent


Case Fatality Rate by AIS Body Region

Note: an incident may involve multiple body regions, and, if so, the patient will be counted in each of the categories in which there is an injury.

Figure

23

Case Fatality Rate by AIS Body Region

0.00

2.00

4.00

6.00

8.00

10.00

12.00

Head

Face

Neck

Thor

ax

Abdo

men

Spine

Uppe

r Ext

remity

Lower

Ext

remity

Exte

rnal

NK/ N

R

AIS Body Region

Cas

e F

atal

ity

Rat

e (%)


Incidents by Protective DevicesFigure

24

Incidents by Protective Devices

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

None

Shoulder Belt

Lap Be

lt

Airbag P

resent

Helmet

(e.g. bi

cycle, sk

iing,

motorcy

cle)

Other

Protec

tive Clot

hing (

e.g., p

added lea

ther p

ants)

Child Rest

raint

(booster

seat,

child

car se

at)

Protec

tive Non-

Clothing Gear

(e.g., s

hin gu

ard)

Eye Pr

otection

Personal

Floatatio

n Device

Not App

licable

NK/ NR

Protective Devices

Perc

ent


Median Total EMS Length (Mins) by Mechanism of Injury

Figure

25

Median Total EMS Length (Mins) by Mechanism of Injury

010203040506070

Nat

ural

/env

iron

men

tal,

Oth

er

Tra

nspo

rt,

othe

r

Mac

hine

ry

Dro

wni

ng/s

ubm

ersi

on

Ove

rexe

rtio

n

Fall

Mot

or V

ehic

le T

raffi

c

Hot

obj

ect/

subs

tanc

e

Nat

ural

/env

iron

men

tal,

Bite

s an

d st

ings

Mechanism of Injury

Num

ber

of M

inute

s


Median Total EMS Length (Mins) by Injury Severity Score

Figure

26

Median Total EMS Length (Mins) by


40

41

42

43

44

45

46

47

1-8 9-15 16-24 >24


Num

ber

of M

inute

s


Median Length of Stay (Days) by Mechanism of Injury

Figure

27

Median Length of Stay (Days) by Mechanism of Injury

0112233445

Fall Motor Vehicle

Traffic

Transport,

other

Firearm Fire/ flame Machinery

Mechanism of Injury

Num

ber

of D

ays


Median Length of Stay (Days) by Injury Severity Score

Figure

28

Median Length of Stay (Days) by Injury Severity Score

0

1

2

3

4

5

6

7

8

1-8 9-15 16-24 >24


Num

ber

of D

ays


Median Ventilator Days by Mechanism of InjuryFigure

29

Median Ventilator Days by Mechanism of Injury

0123456789

10

Fire

/flam

e

Hot obj

ect/

subs

tanc

e

Motor

Veh

icle Tr

affic

Overe

xerti

on

Tran

spor

t, ot

her

Machin

ery

Pede

strian, oth

er

Natu

ral/en

viron

men

tal,.

..

Mechanism of Injury

Num

ber

of D

ays


Median Ventilator Days by Injury Severity Score

Figure

30

Median Ventilator Days by Injury Severity Score

0.00

2.00

4.00

6.00

8.00

10.00

1-8 9-15 16-24 >24


Num

ber

of D

ays


Median ICU Days by Mechanism of InjuryFigure

31

Median ICU Days by Selected Mechanisms of Injury

0

24

68

10

Mechanism of Injury

Num

ber

of D

ays


Median ICU Days by Injury Severity ScoreFigure

32

Median ICU Days by Injury Severity Score

0

1

2

3

4

5

6

7

8

1-8 9-15 16-24 >24 NK/ NR


Num

ber

of D

ays


Incidents by ED Discharge DispositionFigure

33

Incidents by ED Discharge Disposition

0.005.00

10.0015.0020.0025.0030.0035.0040.0045.00

DiedFloor bed (general admission, non specialty un..

Home with services

Home without services

Intensive Care Unit (ICU)

Left against medical advice

Observation unit (unit that provides < 24 hou...

Operating Room

Other (j ail, institutional care facility, mental ...

Telemetry/ step-down unit

Transferred to another hospital

NK/ NR

ED Discharge Disposition

Perc

ent


Reasons for Death in Emergency DepartmentFigure

34

Reasons for Death in Emergency Department

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

DOA: Declared dead on

arrival with minimal or no

resuscitation

Death after failed

resuscitation attempt (no

response within 15 minutes)

Died in ED (other than failed

resuscitation attempt)

Num

ber

of C

ases


Incidents by Hospital Discharge DispositionFigure

35

Incidents by Hospital Discharge Disposition

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

Disc

harg

e/Tr

ansf

erre

d

to h

ome

unde

r ca

re o

f

Disc

harg

ed h

ome

wit

h

no h

ome

serv

ices

Disc

harg

ed/T

rans

ferr

ed

to S

kill

ed N

ursi

ng

Disc

harg

ed/T

rans

ferr

ed

to a

n In

term

edi

ate

Disc

harg

ed/T

rans

ferr

ed

to a

noth

er a

cute

car

e

Disc

harg

ed/T

rans

ferr

ed

to a

noth

er t

ype

of

Disc

harg

ed/T

rans

ferr

ed

to h

ospi

ce c

are

Expi

red

Left

aga

inst

med

ical

advi

ce

Not

App

licab

le

NK/

NR

Hospital Discharge Disposition

Perc

ent


Incidents by Hospital ComplicationsFigure

36

Incidents by Hospital Complications

0.00

0.50

1.00

1.50

2.00

2.50

Pneumonia

Acute respiratory distress syndrome (ARDS)

Deep Vein Thrombosis (DVT) / thrombophlebitis

Acute renal failure

Systemic sepsis

Cardiac arrest with CPR

Coagulopathy

Decubitus ulcer

Drug or alcohol withdrawal syndrome

Pulmonary embolism

Complications

Perc

ent


Incidents by RegionFigure

37

Incidents by Region

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00


Region

Perc

ent


Case Fatality Rate by RegionFigure

38

Case Fatality Rate by Region

0.00

1.00

2.00

3.00

4.00

5.00

6.00


Region

Cas

e F

atal

ity

Rat

e (

%)


Mechanism of Injury by RegionFigure

39

Mechanism of Injury by Region

0.005.00

10.0015.0020.0025.0030.0035.0040.0045.00

Motor

Veh

icle Tr

affic

Fall

Stru

ck by, aga

inst

Tran

spor

t, ot

her

Fire

arm

Cut/

pier

ce

Mechanism of Injury

Perc

ent



Injury Severity Score by RegionFigure

40

Injury Severity Score by Region

0

10

20

30

40

50

60

1-8 9-15 16-24 >24 NK/ NR

ISS Category

Perc

ent



Resources

• www.ntdb.org for more information about NTDB

• www.ntdbdatacenter.com to transmit data to NTDB

• www.ntdsdictionary.org for information on the new data standard

http://www.ntdb.org/

http://www.ntdbdatacenter.com/

http://www.ntdsdictionary.org/

NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide...

Documents

Transcript of NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide...