The trauma registry is a disease-specific data collection composed of uniform data elements that describe the injury event, demographics, prehospital information, diagnosis, care, outcomes, and costs of treatment of injured patients.”[i] The American College of Surgeons (ACS) thus recognizes the dynamics and value of the trauma registry. This however is just the starting point of something much larger, the National Trauma Data Bank, which is the largest repository of trauma data to date.
The rudimentary principle of a national dataset is to have a standardized inclusion criterion. This standardization is necessary to accomplish consistency of findings. It is the foundation of benchmarking reports, allowing trauma centers to compare their care and outcomes against other facilities with confidence that the sample group is the same. This confidence is also paramount for trauma system development and research.
The next critical step is to ensure that the uniformed data elements have a standardized definition. During 2004 – 2006, the ACS Committee on Trauma (COT) subcommittee on Trauma Registry Programs was supported by the U.S. Health Resources and Services Administration (HRSA) to devise a uniform set of trauma registry variables and associated variable definitions. Thus, the National Trauma Data Standards (NTDS) Data Dictionary was developed and released in 2007. This culmination of work would maximize participation by all state, regional and local trauma registries. Thus, to date, the National Trauma Data Bank (NTDB) is the largest aggregation of the U.S. trauma registry data ever assembled.
These are the basics, but how does this really affect the local trauma registry and the institutional programs that it supports. First let us review the 2021 NTDS inclusion criteria. The “major” change for 2021 is the elimination of burns. “The exact inclusion and exclusion criteria used to select patients for entry into a trauma registry vary across hospitals. Some trauma centers, trauma systems, and state agencies modify the inclusion and exclusion criteria to address the specific needs of their patient populations.”[ii]
For clarity, burns are no longer “submitted” to the NTDB, but may still be “included” into your hospital trauma registry if burn patients are part of your program. This may simply require an additional step depending on your trauma registry software vendor when preparing your NTDB/TQIP submission. For example, in some software there is an “EXCLUDE” from NTDB checkbox. Simple click this button, and this patient will not be included in your NTDB submission. In other software, you may need to create a filter to “EXCLUDE” certain patient groups (such as burns) before you run the submission file.
We point this out specifically to encourage hospital trauma registrars to first and foremost concentrate on the needs of their internal programs. If you think about the patient inclusion criteria like a triangle, the base of the triangle or broadest point is hospital level patients, and the very tip top are the TQIP patients. As you know TQIP patients must meet additional criteria above that of NTDS. For example, TQIP patients must have an injury with an Abbreviated Injury Scale (AIS) of 3 in at least one body region. Thus, the most “patients” and “data elements” collected will be on the hospital level base. With this picture in mind, remember the NTDB is a uniformed collection (patients and data elements) to be consistent for national comparison.
Keeping these same principles in mind, let us apply this to data elements. For 2020 the NTDS listed 23 distinct Pre-Hospital Information Data Elements, and for 2021 only 5. For many trauma registrars it was a quick sense of excitement with anticipation their workload just decreased. The data elements from 2020 included initial vital signs which are looked at from a case review prospective for performance improvement. In the 2021 NTDS the key data element is the EMS Patient Care Report Universally Unique Identifier (UUID). The UUID is a number that is automatically generated when the EMS agency enters their data into the NEMSIS database, similar to when a patient is entered into a trauma registry and a unique number is assigned by the software.
By capturing the UUID number as part of the NTDS, the ability to link databases in the future is possible. However, trauma registrars may still need to capture all the EMS data elements to still meet their hospital level needs and potentially the reporting requirements of their state. Remember just because it is not captured with NTDS does not necessarily mean it does not need to be capture “locally”.
The goal of the NTDB 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 in the United States. The goal of the hospital trauma registry is to support that mission, as well as assist in the operation of their own trauma center. By focusing on data driven performance improvement, we change the care of the injured one patient at a time, one facility at a time, contributing then to the overall optimal care of the injured.