Ohio’s Trauma Registry
REHAB Data Collection
Glenn, RN Chief – Trauma, Information & Medical Section
Ohio Department of Public Safety Division of Emergency Medical
Ohio’s Trauma Registry
Authorized by ORC 4765.06
– Senate Bill 98, in 1992 – Trauma Registry – EMS Incidence Reporting
Ohio’s Trauma Registry
WHY?
– Lack of data is a primary factor in inadequate emergency planning – Healthcare needs to be evidence based – Education/curriculum development – Research is severely hindered by incomplete data – Injury Prevention needs to be data-driven – Outcome measures in healthcare are a high priority
Current Registry Requirements
Trauma related deaths Identification of trauma patients Monitoring of trauma patient care data Determination of uncompensated care Other data specified by the EMS Board
Ohio Trauma Registry
EMS Board has adopted rules that;
– – – – Establish an Advisory Committee Assure confidentiality of submitted data Assure no individual provider can be identified Create risk adjusted reports to allow for differences in severity – Prevent use of data in civil lawsuit – Recognizes regional trauma registries
– Ohio Administrative Code 4765-4
Trauma Registry Advisory Committee
Appointed by EMS Board, as a subcommittee of the state trauma committee to oversee the operation of the OTR 18 Members
– – – – – – – 2 Surgeons, 2 ED physicians, 2 Nurses, 2 Trauma Registrars 2 Hospital Representatives 2 Health Information Professionals 1 EMS Provider 1 Rehabilitation Representative 1 County Coroner 1 PM& R Physician 1 Regional Trauma Registry Representative 1 Consumer, not affiliated with an EMS provider
Who Reports to the Registry?
Required to Report
– ✔ Hospitals – ✔ County Coroners – ✘ Inpatient Rehabilitation Facilities – Ambulatory Surgical Facilities – Nursing Facilities – County Homes/County Nursing Homes – Other State and Public Agencies
When is Data Submitted?
All data is due 90 days following the end of each quarter
– – – – 1st quarter 2004 data 2nd quarter 2004 data 3rd quarter 2004 data 4th quarter 2004 data DUE June 29, 2004 DUE September 28, 2004 DUE December 29, 2004 DUE March 31, 2005
EMS Board policy for extension to deadline
– On the EMS Website http://ems.ohio.gov/ohio_trauma_registry.htm
What Data is Submitted?
Inclusion/exclusion criteria are found in the OTR REAHAB data dictionary Data Dictionary is on-line
– http://ems.ohio.gov/ohio_trauma_registry.htm – Hard copies available from Division of EMS
ICD-9-CM Diagnosis Codes on discharge from acute care hospital ICD-9-CM Diagnosis Codes 800.00 – 819.1 Fractures ICD-9-CM Diagnoses Descriptions
821.00 – 904.9
911.0, 911.1, 912.0, 912.1 916.0, 916.1, 919.0, 919.1
Fractures, dislocations/sprains, intracranial injury, internal injury of thorax, abdomen and pelvis, open wounds, injury to blood vessels
Abrasions/friction burns to trunk, shoulder and upper arm Abrasions / friction burns hip, thigh, leg, ankle, other or multiple sites
920 – 929.9
940.0 – 959.9
Contusions and crush injury
Burns, injury to nerves and spinal cord, traumatic complications and unspecified injury
987.9
991.0 – 991.6 994.0, 994.1, 994.7, 994.8 995.50 – 995.59
Smoke inhalation
Frostbite, hypothermia and external effects of cold Asphyxiation, strangulation, drowning, and electrocution Child maltreatment and abuse
***OR***
ICD-9-CM Diagnoses
348.1 Anoxic Brain Injury
348.4
348.5,
Uncal herniation
Cerebral Edema
AND WITH ANY OF THE FOLLOWING External Cause Codes (E-Codes)
E-CODE
E800 – E848.8 E878 – E905.0 E906.0 – E928.8 E950.0 – E998.9
348.8
372.72 518.5 784.7
Pneumocephalus
Subconjunctival hemorrhage Traumatic ARDS Epistaxis
Adult Impairment Group Code on Admission to Rehabilitation Facility
Brain Dysfunction
02.1 Non-traumatic injury * 08.12
08.2 08.3 * must be associated with an acceptable E-code.
Orthopedic Disorders
Status Post Bilateral Hip Fractures
Status Post Femure (shaft) Fracture Status Post Pelvic Fracture
02.21
02.22
Traumatic, open injury
Traumatic, closed injury
08.4
Status Post Major Multiple Fractures
Spinal Cord Dysfunction, Traumatic
004.210
04.211 04.212
Paraplegia, unspecified
Paraplegia, incomplete Paraplegia, complete 05.1 05.2
Amputation of Limb
Unilateral Upper Limb above the elbow (AE) Unilateral Upper Limb below the elbow (BE)
04.220
04.2211 04.2212 04.2221 04.2222 04.230
Quadriplegia, Unspecified
Quadriplegia, Incomplete C1-4 Quadriplegia, Incomplete C5-8 Quadriplegia, Complete C1-4 Quadriplegia, Complete C5-8 Other Traumatic Spinal Cord Dysfunction
05.3
05.4 05.5 05.6 05.7 05.9
Unilateral Lower Limb above the knee (AK)
Unilateral Lower Limb below the knee (BK) Bilateral Lower Limb above the knee (AK/AK) Bilateral Lower Limb above/below the knee (AK/AK) Bilateral Lower Limb below the knee (BK/BK) Other amputation
Pediatric Impairment Group Code on Admission to Rehabilitation Facility
Brain Dysfunction
01.221 Traumatic, open injury 7.11 Burns
Burns
01.222
Traumatic, closed injury
1.211
Hypoxemic Ischemic Encephalopathy 6.1
Major Multiple Trauma
Brain + Spinal Cord Injury
Traumatic Spinal Cord Dysfunction
004.210 04.2110 Paraplegia, unspecified Paraplegia, incomplete
6.2
6.3 6.4
Brain + Multiple Fracture/Amputation
Spinal Cord + Multiple Fracture/amputation Other multiple trauma
04.2111
Incomplete Paraplegia T1-9
04.2112
Incomplete Paraplegia T10-L2
04.2113
Incomplete Paraplegia L3-4
Orthopedic Disorders
Orthopedic Conditions
04.2114
Incomplete Paraplegia L5-S1
04.2115
04.2120
Incomplete Paraplegia Sacral
Paraplegia, complete
05.11
05.12
Status Post Hip Fracture
Status Post Femure (shaft) Fracture
How is Data Submitted?
All data is submitted electronically to the EMS web site
http://ems.ohio.gov/ohio_trauma_registry.htm Direct entry of individual record data - or Upload of file with multiple records – 3rd party software users
REHAB Registry
Trauma Rehabilitation Reporting
– – – – All In-patient rehabilitation facilities Web based entry/submission process 36 Data fields, all are required Data collection scheduled to begin January 1, 2005
Upload File
Upload File function is needed for users that utilize a 3rd party software to collect data
Download Records
Facilities can pull back all the data that they submit . In an Excel file, this allows for graphs and reports to be generated
EMSIRS
EMS Incident Reporting System
EMS agencies required to report
– – – – – – Transporting agency reports data Web based entry/submission system 90 fields, 52 are required, 38 are option/local use only Data collection began January 1, 2002 Over 1 million records in the system to date EMS agencies MUST participate in order to be eligible for the EMS/Trauma grant program
5.2 million dollars awarded by the EMS Board annually
Ohio Trauma Registry TRAUMA
ALL hospitals required to report
– – – – – – Transporting agency reports data Web based entry/submission system 52 fields, all are required Data collection began January 1, 1999 Over 100,000 records in the system to date Hospitals MUST participate in order to be eligible for the EMS/Trauma grant program, or to participate in DEMS funded programs
OTR Special Projects
Data Validation Study
– Validate 12 data points
ICD-9-CM diagnosis and external cause codes ED vital signs and Glasgow Coma Scale scores DOB, Gender, Zip code
– 1000 records – 28 Hospitals 15 Non trauma centers, 18 trauma centers)
OTR Special Projects
Probabilistic Linkage
– Links records in separate data bases that do not have a Unique Identifier
OTR Special Projects
Probabilistic Linkage Does Work!
– Used by the CDC and National Highway Traffic Safety Administration – Critical fields from a record in each database are evaluated for the “probability” that they are the same incident/patient – We’ll use probabilistic linkage to link OTR to
EMSIRS Ohio Crash Records REHAB Data base
When complete, Ohio’s Trauma Registry will be the most comprehensive in the county!
Ohio’s Trauma Registry
The Goal Provide Data for •Development of Public Policy •Healthcare education •Injury Prevention •Research