Trauma Registry

The Bureau of Acute Care Systems (BACS) requires every Mississippi licensed acute care facility (hospital) having an organized emergency service or department to submit data to the State Trauma Registry. Currently we have 86 facilities submitting data to the Registry.

There are four objectives of the trauma registry: performance improvement, enhanced hospital operations, injury prevention, and medical research. Of the four, performance improvement is the primary reason for maintaining a trauma registry. The registry is designed to provide information that can be used to improve the efficiency and quality of trauma care, thereby improving patient outcomes. All designated trauma centers in Mississippi are required to participate in some type injury control activities (injury prevention) to reduce the incidence of trauma in our State. Data from trauma registries also plays an integral part in medical research as we continue to implement processes and procedures to improve patient care and reduce the incidence of trauma in Mississippi.

The state registry system is designed primarily to collect data on only those patients with serious injuries. It is also designed to identify system issues, such as over and under triage, at the regional and state levels. In order to track these patients effectively, BACS has identified criteria for a patient to be included in the registry at the local level. This inclusion criteria is REQUIRED for every Mississippi licensed acute care facility (hospital) having an organized emergency service or department. ALL FACILITIES MUST INCLUDE, AT A MINIMUM, ALL PATIENTS THAT MEET THESE CRITERIA, regardless of payment source, indigent status, etc.

Trauma

ICD-10 Code:

• S00-S99 with 7th character modifiers of A, B, or C only
  • (Injuries to specific body parts – initial encounter)
• T07 (unspecified multiple injuries)
• T14 (injury of unspecified body region)
• T79.A1-T79A9 with 7th character modifier of A only
  • (traumatic compartment syndrome-initial encounter)

Burn Patients

ICD-10 Code:

• T20-T28 with 7th character modifier of A only
  • (Burns by specific body parts – initial encounter)
• T30-T32 (burn by TBSA percentages)

Including:

• Any inhalation injury
• 2nd or 3rd degree burns > 5% TBSA
• Any 2nd or 3rd degree burn of 1% or greater to:
  • Hands, Feet, Joints, Face, or Perineum

Plus any of the following: (except burn patients)

• Transferred between acute care facilities by EMS
  • Ground or Air
• Admission to the Hospital for any LOS
  • Excludes ED>OR>Home (from PACU)
• Died
• Triaged to a Trauma Hospital by EMS
• Trauma Team Activation
• Any Trauma Patient received via Air Ambulance

The following should be excluded:

• Late Effects (≥ 30 days PTA)
• Foreign Bodies
• Extremities and/or hip fractures from same height fall in patients over age of 70.

I. Utilization of the Trauma Registry

As previously noted there are four objectives of maintaining the trauma registry: performance improvement, enhanced hospital operations, injury prevention, and medical research. If the registry is utilized appropriately, performance improvement can be done in a much more efficient manner than if done manually. Secondly, the registry can help in managing resource allocation and utilization through daily logs, summaries, etc. Hospitals can use data from the registry to identify areas with the highest incidence of trauma and target those areas for injury prevention programs. Injury control issues can be identified at the local, regional, and state levels, thereby providing the basis for developing and implementing injury prevention programs statewide. Finally, standardization of the data, allows quality data to be disseminated and used in clinical research and decision making.

II. Prerequisite for a State Designated Trauma Registry Patient

All state designated patients must have a primary diagnosis should be ICD10 code and meet at least one of the other six inclusion criteria. Only burn patients with an ICD 10 code qualify for inclusion into the trauma registry. Plus any one of the following:

• Trauma Team Activation (Alpha/Bravo)
• Transferred between acute care facilities (in or out) by EMS (Ground or Air)
• Admission to the hospital for any length of time to any area. (This excludes patients that go to the OR from ED and are discharged home from PACU)
• Died
• Any trauma patient brought to your facility by Air Ambulance
• Triaged (per State Trauma Destination Guidelines) to a trauma hospital by EMS regardless of severity. Documentation on the EMS Patient Care Report (PCR) must reflect that the patient was brought to your facility for a needed resource

If the primary diagnosis falls within the range of ICD 10 code, they should not be included. These injuries do not have an AIS value associated with them, making it impossible to calculate an Injury Severity Score (ISS). If a patient has any of these injuries, secondary to a qualifying primary diagnosis, then they should be included and documented, along with any other injuries, burns, etc.

The trauma registry is designed to evaluate serious injuries caused by mechanical forces. For this reason, isolated injuries, such as extremities and/or hip fractures from same height fall in patients over the age of 70, are excluded. This will primarily be seen in elderly patients who suffer from the injury not because of the event, but because of osteoporosis. Some of these may have to be evaluated and may come down to clinical judgment. Also, trauma hospitals may want to collect this information for reasons internally. This is recommended, if the volume is manageable by the facility. However, it is not a requirement of the state and the record should be marked "N" in the "Include in Central Site Submission" field.

III. Inclusion Requirements After Prerequisite Is Met

Listed below is additional detail on requirements a patient must meet for inclusion after the prerequisite requirement of applicable ICD 10 code has been met. A patient must meet any one of the following.

1. Trauma Team Activation (Alpha/Bravo)
   Any trauma patient triaged or transferred into a trauma center that results in the activation of the trauma team must be entered into the registry. This will allow a hospital's trauma program manager to monitor appropriateness of trauma team activation protocols.

2. Admitted to intensive/critical care unit (no minimum days required)
   Any injury sustained that warrants admission to ICU/CCU must be included.

3. Transferred between acute care facilities (in or out) by EMS (Ground or Air)
   If a trauma center receives a patient that has sustained an injury that the center is unable to treat and transfers the patient to a higher or more appropriate level of care, this patient must be included in the registry at both the transferring and receiving hospitals. This will allow regions to identify over and under triage that is occurring.

4. Admission to the hospital for any length of time to any area. (This excludes patient that go to the OR from ED and are discharged home from PACU)
   In some situations, patients may be hospitalized for reasons other than the injury, i.e. medical, social, etc. It is recommended that hospitals include all of these for evaluation in their own facility, but only those hospitalized due to the injury should be submitted to the state.

5. Died
   All trauma deaths must be entered in the registry and evaluated for preventability at all levels: pre-hospital, transferring hospital, and receiving hospital

6. Any trauma patient brought to your facility by Air Ambulance
   Triaged (per State Trauma Destination Guidelines) to a trauma hospital by EMS regardless of severity. (Documentation on the EMS Patient Care Report (PCR) must reflect that the patient was brought to your facility for a needed resource.) If any patient is triaged to a trauma center by pre-hospital care providers (per State Trauma Destination Guidelines), the patient must be included in the registry. This is how medical direction for pre-hospital care at the local and regional levels will monitor appropriateness of triage protocols.