The Bureau of Emergency Medical Services (BEMS) 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 92 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 improve 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, BEMS 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.
All state designated patients must have a primary diagnosis of ICD-9 diagnosis code 800-959.9, plus any one of the following:
- Transferred between acute care facilities (in or out)
- Admitted to critical care unit (no minimum)
- Hospitalized for three or more calendar days
- Died after receiving any evaluation or treatment
- Admitted directly from Emergency Department to Operating Room for major procedure, excluding plastics or orthopedics procedures on patients that do not meet the three day hospitalization criteria
- Triaged (per regional trauma protocols) to a trauma hospital by pre-hospital care regardless of severity
- Treated in the Emergency Department by the trauma team regardless of severity of injury
The following primary ICD-9 diagnosis codes are excluded and should NOT be included in the trauma registry:
- ICD-9 Code 905-909 (Late effects of injuries)
- ICD-9 Code 930-939 (Foreign bodies)
- Extremities and/or hip fractures from same height fall in patients over the age of 65.
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 of ICD-9 diagnosis code 800-959.9 and meet at least one of the other seven inclusion criteria. Exclusions to this rule are as follows:
- ICD-9 Code 905-909 (Late effects of injuries)
- ICD-9 Code 930-939 (Foreign bodies)
- Extremities and/or hip fractures from same height fall in patients over the age of 65.
If the primary diagnosis falls within the range of 905-909 or 930-939, 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 65, 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 ICD9 code has been met. A patient must meet any one of the following.
Transferred between acute care facilities (in or out)
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.Admitted to intensive/critical care unit (no minimum days required)
Any injury sustained that warrants admission to ICU/CCU must be included.Hospitalization for three or more calendar days
Any patient hospitalized for three or more calendar days must be included. 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.Died after receiving any evaluation or treatment
All trauma deaths that receive any evaluation or treatment in the Emergency Department must be entered in the registry and evaluated for preventability at all levels: pre-hospital, transferring hospital, and receiving hospital.Admitted directly from Emergency Department to Operating Room for major procedure, excluding plastics or orthopedics procedures on patients that do not meet the three day hospitalization criteria
All patients that are admitted directly from the ED to the operating room for a major procedure must be included. Any plastic and/or orthopedic procedures that do not meet one of the other criteria for inclusion must not be entered into the trauma registry.Triaged (per regional trauma protocols) to a trauma hospital by pre-hospital care regardless of severity
If any patient is triaged to a trauma center by pre-hospital care providers (per regional trauma protocols), 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.Treated in the emergency department by the trauma team regardless of severity of injury
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.
