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Trauma Registrar

Trauma Registrar. Welcome to the world of trauma! Mary J. Anderson, RN, MSN, CEN, CPEN Melody Mulhall, Lead Pediatric Trauma Registrar American Family Children’s Hospital Trauma Program Madison, WI December 16, 2013. Trauma Registry History. February 17, 1976

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Trauma Registrar

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  1. Trauma Registrar Welcome to the world of trauma! Mary J. Anderson, RN, MSN, CEN, CPEN Melody Mulhall, Lead Pediatric Trauma Registrar American Family Children’s Hospital Trauma Program Madison, WI December 16, 2013

  2. Trauma Registry History • February 17, 1976 • Dr. James Styner – Orthopedic Surgeon • Piloted a 6-seat Beach Barron twin from Los Angeles to home in Lincoln, Nebraska • Crashed - killing his wife, Charlene, and severely injuring his 4 children, Christopher (10), Richard (8), Randal (7), Kimberly (3) • Local hospital was “closed”! Once opened, the physicians had little training in trauma care • "When I can provide better care in the field with limited resources than my children and I received at the primary facility, there is something wrong with the system and the system has to be changed."

  3. Trauma Registry History • 1978 – Dr. Styner collaborated with his colleagues to develop the prototype Advanced Trauma Life Support course • The American College of Surgeons Committee on Trauma pledged “to improve the care of the injured through systematic efforts in prevention, care, and rehabilitation."

  4. Trauma Registries • National – National Trauma Data Bank (NTDB) • State – Wisconsin Trauma Registry • Hospital – University of Wisconsin Hospital and Clinics/American Family Children’s Hospital (Over 140 hospitals in the State of Wisconsin, alone).

  5. “Green Book” for Trauma(soon to be Orange)

  6. NTDB Inclusion

  7. Wisconsin-Specific Same Level Falls Defining WI Same Level Falls “Excluding falls from same level (ground level fall*) resulting in isolated closed distal extremity fracture or isolated hip fracture.” Exclude patients with same level fall/ground level fall*, if one of the following is the only injury present: Isolated Closed Distal Extremity Fracture consists of: Fracture below elbow excluded (radius & ulna fracture is considered one fracture) Fracture below knee excluded (tibia & fibula fracture is considered one fracture) Isolated Hip Fracture consists of: Fracture of the femur: Subcapital Basilar neck Intertrochanteric Subtrochanteric *Ground Level Fall: Fall from standing, including slipping, tripping or stumbling. Please note: ** ANY OPEN FRACTURE IS INCLUDED Any Injury occurred: Skiing Skateboarding Snowboarding Rollerblading Non-motorized scooter Rollerskates (includes In-line & Heelies) INCLUDE DUE TO VELOCITY

  8. NTDB • The largest aggregation of US/Canadian trauma registry data • Is a compilation of information about traumatic injuries and outcomes • The goal is to inform the medical community, the public, and decision makers about a wide variety of issues that characterize the current state of care for injured persons

  9. NTDB • Epidemiology • Resource Allocation Non-helmeted motorcyclists: A burden to society? A study using the National Trauma Data Bank RESULTS: A total of 9,769 patients were identified by the NTDB of which 6756 (69.2%) were helmeted and 3013 (30.8%) were non-helmeted. Helmet use was associated with lower injury severity, mortality, and resource utilization. Non-helmeted motorcyclists accrued greater hospital charges and were significantly less likely to have health insurance. When controlling for alcohol or drug use, mortality continued to be significantly associated with non-helmet use. CONCLUSION: Non-helmeted motorcyclists have worse outcomes than their helmeted counterparts independent of the use of alcohol or drugs. Furthermore, they monopolize more hospital resources, incur higher hospital charges, and as non-helmeted motorcyclists frequently do not have insurance, reimbursement in this group of patients is poor. Thus, the burden of caring for these patients is transmitted to society as a whole.

  10. NTDB • Acute Care Predicting Outcomes Using the National Trauma Data Bank: Optimum Management of Traumatic Blunt Carotid and Blunt Thoracic Injury Results In all, 2089 vascular traumas were identified. Patients with blunt thoracic trauma within the highest injury severity score (ISS) range (61-75) had a significant survival advantage when observation was compared with endovascular management (P < .05). In the carotid trauma cohort, those with the highest ISS range (61-75) had a significant survival advantage with open surgery compared with observation (P < .01). Conclusion Patients with traumatic blunt thoracic injury and an ISS > 61 appeared to benefit from endovascular approaches compared with open management. Patients with blunt carotid trauma and an ISS > 61 appeared to benefit from open surgical management.

  11. NTDB • Injury Control/Prevention • Research • Education

  12. Process/Quality Improvement

  13. TCAA

  14. Trauma Registrar • Abstracts > 300 data elements per patient abstraction • New ACS recommendations – 500 to 750 patient abstractions per year vs current 750-1000 • Participates on Hospital, Regional, and State committees • Collaborates with EMS agencies • Participates in inter-rater reliability exercises as required by the ACS • Data submission to State, NTDB, and ABA (burn) • System case finding

  15. Trauma Registrar Training • Credentialing CSTR – Certified Specialist in Trauma Registry (American Trauma Society) CAISS – Certified Abbreviated Injury Scale Specialist (Association for the Advancement of Automotive Medicine)

  16. Trauma-specific AIS Coding • AIS = Abbreviated Injury Scale 1). Anatomical-based coding system created by the Association for the Advancement of Automotive Medicine (AAAM). 2). Classifies and describes the severity of specific individual injuries. 3). Represents the threat to life. 4). Used world-wide 5). Correlates with ICD-9/ICD-10

  17. AIS Coding • Score describes the injury: Type Location Severity Using 7 numbers – 12(34)(56).7 1 = body region 2 = type of anatomical structure 3,4 = specific anatomical structure 5,6 = level 7 = severity of score

  18. AIS Coding • Classifies severity on a six point ordinal scale: 1. Minor 2. Moderate 3. Serious 4. Severe 5. Critical 6. Maximal (currently untreatable)

  19. AIS Coding • Body Regions: Head or Neck Face Chest Abdomen or Pelvis contents Extremities or Pelvic Girdle External Index Severity Score (ISS) ISS = A2 + B2 + C2 where A B C are the AIS scores of the three most injured ISS body regions

  20. Index Severity ScoresISS The ISS takes values from 0 to 75 and is virtually the only anatomical scoring system that correlates with mortality, morbidity, hospital lengths of stay, and other measures of injury severity.

  21. Trauma Registrar Is it in your future?

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