Content Information
According to the ACS-COT (2014), the role of the TPM is to, “supervise collection, coding, scoring, and developing processes for validation of data. Design the registry to facilitate performance improvement activities, trend reports and research while protecting confidentiality” (p. 43).
The State of Iowa currently uses ImageTrend as their software vendor for the collection of Iowa’s trauma data. Access to the system can be granted by any of the State of Iowa Trauma Program Administrators. Current contact information can be found under the references section of the manual.
As outlined in Iowa Administrative Code 164 – 134 Trauma Care Facility Categorization and Verification, 80 percent of trauma incidents should be entered into the ImageTrend Registry no later than 60 days after discharge. The inclusion criteria for incidents that should be entered into the trauma registry can be found in the data dictionary developed by the State of Iowa Trauma Program. Level III facilities in Iowa are required to submit their data to the National Trauma Data Bank, along with submission to the State of Iowa Trauma Registry. Information on submission to the National Trauma Data Bank can be found at FACS.org.
The data dictionary provides the TPM with guidance for completion and definitions of the data fields contained in the trauma registry. Each data field has a definition associated with the data element, a field value, additional information, including whether or not the field is required by the State, National Trauma Data Bank (NTDB), or the Trauma Quality Improvement Program (TQIP), the State Validation score (the number of percentage points that will be deducted from the incident’s validity score due to blank or invalid values) for the data element, and the ImageTrend data element tag. The definition of the data field helps to clarify what the field is actually asking for. The field value describes what format the field is asking for the data in as either alpha, numeric, or month/day/year, or whether it is looking for time in military, or open text, etc. Direct questions or issues related to the ImageTrend Registry to the Statistical Research Analyst at the State Trauma Program.
While filling in fields, it is important to assure the accuracy of each incident. Public health uses the registry for many different, but equally important initiatives. The State Trauma Program uses the registry to guide research, injury prevention initiatives, develop education and training programs, and advise the Trauma System Advisory Council and State Legislators on injury data across the State. On a local level, TPMs should use the registry to guide performance improvement activities, tailor community outreach and injury prevention activities, and develop education and training programs for staff members.
It is important to note and make sure to educate any registry staff on the importance of the “diagnosis tab” while entering an incident in ImageTrend. Using the diagnosis “look up” button is an easy way to drill down to the most specific ICD-10 code available for the patient. Providing the most specific code for each diagnosis can help the Department of Public Health reposition the trauma system, in order to meet the challenge of protecting and improving the health of all Iowans. The primary diagnosis code must end in either the letter “A” or if unable to be as specific to drill down to the letter A, the ICD-10 code can end in a number. This qualifier “A” represents an initial encounter and has to be used for as the primary diagnosis code.
For example, for the primary diagnosis on a patient with an Anterior displaced Type II dens closed fracture, the ICD-10 code should either be S12.110A or can be S12.1, S12.10, S12.11, or S12.110 (if not able to further specify). It cannot be S12.110D or S12.110G. However, those codes can be used as non-primary diagnosis codes.
The primary diagnosis code that ends in “A” should be the first diagnosis code listed for the patient. The order of the codes can be changed by dragging and dropping the primary diagnosis code by the large bolded arrows next to the correct code. An example is provided below:
Any questions should be directed to the Statistical Research Analyst at BETS.
Equally important to the diagnosis code is the Abbreviated Injury Scale (AIS). The best way to find the most accurate AIS score is to utilize the “look up” button next to the field. According to the Association for the Advancement of Automotive Medicine, the AIS, “provides standardized terminology to describe injuries and ranks injuries by severity” (n.d). The Injury Severity Score (ISS) is calculated from the AIS.
ISS splits the body into six categories: head/neck, face, chest, abdomen, extremity, and external (skin). Only the highest AIS number in each body region is used to calculate the ISS. The highest injured body region scores are then squared. The three highest squares are then added together to produce the ISS. An example is below:
| Body Region |
Injury Description |
AIS |
Square Highest 3 AIS |
|---|---|---|---|
|
Head/Neck |
Cerebral contusion |
3 | 9 |
|
Face |
No injury |
0 | |
|
Chest |
Flail Chest |
4 | 16 |
| Abdomen | Minor Contusion Liver | 2 | |
|
|
Complex Rupture Spleen | 5 | 25 |
|
Extremity |
Fractured Femur | 3 | 9 |
| External (skin) | No injury | 0 |
- Addition of highest three AIS squares in this injured patient: 9 + 16 + 25 = 50
- This patient’s ISS is 50.
After the calculation of the ISS, the next step is to understand what an ISS of 50 means for the patient. ISS ranges from 1-75. If an injury is assigned an AIS of 6 (un-survivable injury), the ISS score is automatically assigned a 75. ISS correlates linearly with mortality, morbidity, and length of hospital stay. Meaning, the higher the score, the greater the risk of mortality, morbidity, and the longer expected length of hospital stay. One of the weaknesses of the ISS is that any error in AIS coding will result in an error in calculated ISS. Therefore, it is vitally important to code the AIS accurately in order to best predict an injured patient’s outcome. An AIS course is available through the Association for the Advancement of Automotive Medicine. Participation in this course may increase the familiarity with the scale and provide clarification to the importance of accuracy while coding traumatic injuries.
The ACS-COT (2014) defines major trauma patients as those with an ISS greater than 16. It is the role of the TPM to supervise the trauma registrar and in many cases act as the trauma registrar. To this end, it is vitally important to understand the necessity for accuracy in coding injuries and keeping an accurate record of the patient. The trauma registry is used for performance improvement in the system, research, and guides injury prevention efforts across the state. If questions remain regarding the trauma registry, entry into the registry, or injury coding contact the Statistical Research Analyst at BETS for assistance.
Data Dictionary
The Iowa Department of Public Health hosts a statewide trauma patient registry. The registry is a web-based system used to collect specific information about patients that have experienced significant traumatic events. All hospitals in Iowa are required to report these data elements. In order to ensure information is collected consistently, the Iowa Department of Public Health provides a Trauma Registry Data Dictionary. This document outlines the requirements for submission and defines each data element within the registry. The data collected through the registry is used for hospital, service area, and statewide performance improvement. The confidentiality of patients is maintained throughout these processes.
Data Reports
Use of the Registry Report to guide community education and outreach activities appropriate for local implementation is encouraged. The State reports guide programs on the most common injuries in the State of Iowa. Reports from the TPM's hospital registry can further identify opportunities for injury prevention and outreach specific to the local community.
For archived trauma registry reports, contact the BEMTS Epidemiologist.
The State of Iowa Trauma Registry has the capability to run registry-based reports to assist a trauma program with registry utilization for performance improvement and patient safety, as well as outreach and education. The following document outlines several such reports that may be useful to a trauma program. For any additional questions regarding the registry and report writer, please contact the BEMTS Epidemiologist.
NTDB Guidance
In order to improve the process for the National Trauma Data Bank (NTDB) annual call for data, the Statistical Research analyst at the Bureau of Emergency and Trauma Services has recorded a tutorial on exporting NTDB data from ImageTrend. If you have any questions, please contact the Statistical Research Analyst at the Bureau of Emergency and Trauma Services.
Tutorials
The following videos are meant to instruct users of the state trauma registry.