National Trauma Data Bank 2009 Pediatric Report

Size: px

Start display at page:

Download "National Trauma Data Bank 2009 Pediatric Report"

Everett Wilkinson
5 years ago
Views:

1 National Trauma Data Bank 009 Pediatric Report 1 of 68

2 Acknowledgments The American College of Surgeons Committee on Trauma wishes to thank the Centers for Disease Control and Prevention (CDC) for their support of the NTDB. of 68

3 NTDB Annual Report 009 Ed i to r s Avery B. Nathens, MD, PhD, FACS, Chair National Trauma Data Bank Subcommittee Richard J. Fantus, MD, FACS, Chair Trauma Registry Advisory Ad Hoc Committee A m e r i c an Co lleg e o f Su r g eo n s Co m m i tt e e o n T r au m a Le ad e r s h i p John J. Fildes, MD, FACS Chair, Committee on Trauma J. Wayne Meredith, MD, FACS Medical Director, Trauma Office Division of Research and Optimal Patient Care Nat i o n al T r au m a Data Ban k Su b co m m i tt e e Pe d iat r i c Su r g e ry Su bspecialt y G r o u p Palmer Q. Bessey, MD, FACS Karen J. Brasel, MD, FACS David E. Clark, MD, FACS Arthur Cooper, MD, FACS Joseph Cuschieri, MD, FACS Richard J. Fantus, MD, FACS Richard J. Kagan, MD, FACS Geoffrey R. Keyes, MD, FACS Mark. A. Malangoni, MD, FACS Michael D. McGonigal, MD, FACS Frederick H. Millham, MD, FACS Allen F. Morey, MD, FACS Charles E. Morrow, Jr., MD, FACS Michael L. Nance, MD, FACS Avery B. Nathens, MD, PhD, FACS Manoj R. Shah, MD, FACS Glen H. Tinkoff, MD, FACS Arthur Cooper, MD, FACS, Chair Guy Brisseau, MD, FACS Charles S. Cox, MD, FACS Mary E. Fallat, MD, FACS Henri R. Ford, MD, FACS William D. Hardin, MD, FACS Richard J. Jackson, MD, FACS Michael L. Nance, MD, FACS Kennith H. Sartorelli, MD, FACS Perry W. Stafford, MD, FACS N. Clay Mann, PhD, MS, Consultant Nat i o n al T r au m a Data Ban k S taff Melanie Neal, Manager Sandra Goble, Statistician Chrystal Price, Data Analyst Christopher Hoeft, Coordinator of 68

4 Editors Note T he Annual Pediatric Report of the National Trauma Data Bank (NTDB) is an updated analysis of the largest aggregation of U.S. trauma registry data ever assembled. In total, the NTDB now contains over million records. The 009 Annual Report is based on 67, admission year records from 567 facilities, while the 009 Annual Pediatric Report is based on 1, admission year records from 55 facilities New in the report this year is an expanded section on facility information. This section includes information on registry inclusion criteria for participating hospitals. This information allows the reader to consider differences in case mix across hospitals while reading the report. Please note that Appendix C contains an analysis of data from the NTDB National Sample Program. The mission of the American College of Surgeons (ACS) Committee on Trauma (COT) is to develop and implement meaningful programs for trauma care. In keeping with this mission, the NTDB is committed to being the principal national repository for trauma center registry data. The purpose of this report 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 our country. It has implications in many areas including epidemiology, injury control, research, education, acute care, and resource allocation. The NTDB Committee would like to thank all of the trauma centers that contributed data and hope that this report will attract new participants. The National Trauma Data Bank Annual Report is available on the ACS Web site as a PDF file and a PowerPoint presentation at In addition, information is available on our Web site about how to obtain NTDB data for more detailed study. Many dedicated individuals on the ACS COT, as well as at trauma centers around the country, have contributed to the early development of the NTDB and its rapid growth in recent years. Building on these achievements, our goals in the coming years include improving data quality, updating analytic methods, and enabling more useful inter-hospital comparisons. These efforts will be reflected in future NTDB reports to participating hospitals as well as in the Annual Reports. Avery B. Nathens, MD, PhD, FACS, Chair National Trauma Data Bank Subcommittee Richard J. Fantus, MD, FACS, Chair Trauma Registry Advisory Ad Hoc Committee 4 of 68

5 of Contents c l i c k D i r e c t l y o n a t i t l e o r S e c t i o n H e ad t o g o t o t h at pa g e Page Editors Note 4 H o s p i ta l I n f o r m a t i o n Page 1 1 Facilities by Pediatric Hospital Association 8 Facilities by Presence of Pediatric Ward 9 Facilities by Presence of Pediatric ICU Facilities by Pediatric Transfer Status Facilities by Pediatric Age Cutoff 1 6A 6B D e m o g r a p h i c I n f o r m at i o n Page Incidents by Age, Case Fatality Rate by Age Incidents and Case Fatality Rate by Age 14 Incidents by Age and Gender, Case Fatality Rate by Age and Gender 17 7 Incidents and Case Fatality Rate by Age and Gender Alcohol Use Drug Use Primary Payment Source 0 6 7A 7B 11A 11B Injury Char ac teristics Page Incidents by Mechanism of Injury, Case Fatality Rate by Mechanism of Injury 11 Incidents and Case Fatality Rate by Mechanism of Injury 1 1 Selected Mechanisms of Injury by Age Case Fatality Rate by Mechanisms of Injury and Age 5 14A 14B Incidents by Mechanism of Injury and Gender, Case Fatality Rate by Mechanism of Injury and Gender 7 14 Incidents and Case Fatality Rate by Mechanism of Injury and Gender Incidents by Comparative Injury Severity Scores Incidents and Case Fatality Rate by Injury Severity Score Incidents by Injury Severity Score and Age Case Fatality Rate by Injury Severity Score and Age 1- Incidents by Work-Related Injuries, Case Fatality Rate by Work-Related Injuries -4 19A 19B 19 Incidents and Case Fatality Rate by Work-Related Injuries 0 0 Incidents and Case Fatality Rate by Intent Incidents and Case Fatality Rate by Location E code 6 Incidents by AIS Body Region 7 Incidents with AIS by AIS Body Region Incidents and Case Fatality Rate by AIS Body Region Incidents by Protective Devices 40 (table of contents continues on next page) 5 of 68

6 6 6 Median Total EMS Length (in Mins) by Mechanism of Injury Median Total EMS Length (in Mins) by Injury Severity Score Median Length of Stay (in Days) by Mechanism of Injury Median Length of Stay (in Days) by Injury Severity Score Median Ventilator Days by Mechanism of Injury Median Ventilator Days by Injury Severity Score 47 Median ICU Days by Mechanism of Injury 48 Median ICU Days by Injury Severity Score Incidents by ED Discharge Disposition Reasons for Death in ED Incidents by Hospital Discharge Disposition 5 Incidents by Hospital Complications 54 Incidents by Hospital Complications Outcomes Page R e g i o n a l A n a ly s e s Page 8 8 Incidents by Region Case Fatality Rate by Region Mechanism of Injury by Region Injury Severity Score by Region Incidents by Urban Influence Codes Case Fatality Rate by Urban Influence Codes Mechanism of Injury by Urban Influence Codes Injury Severity Score by Urban Influence Codes 65 Appendices Page Appendix A: Definition of Trauma Patient 67 Appendix B: E-Code Grouping 68 6 of 68

7 Hospital Information Hospital Information 7 of 68

8 Hospital Information FACILITIES BY PEDIATRIC HOSPITAL ASSOCIATION 1 PEDIATRIC ASSOCIATION False True Total of 68

9 Hospital Information FACILITIES BY PRESENCE OF PEDIATRIC WARD PEDIATRIC WARD False True Total of 68

10 Hospital Information FACILITIES BY PRESENCE OF PEDIATRIC ICU PEDIATRIC ICU False True Total of 68

11 Hospital Information FACILITIES BY PEDIATRIC TRANSFER STATUS 4 PEDIATRIC TRANSFER False True Total of 68

Hospital Information FACILITIES BY PEDIATRIC AGE CUTOFF 5 PEDIATRIC CUTOFF 10 1 0.18 1 1.5 1 10 1.

12 Hospital Information FACILITIES BY PEDIATRIC AGE CUTOFF 5 PEDIATRIC CUTOFF None 5.97 Total of 68

13 Demog r aphic Information Demographic Information 1 of 68

14 Demog r aphic Information INCIDENTS AND CASE FATALITY RATE BY AGE 6 AGE DEATHS CASE FATALITY RATE <1 year 7, , , , , , , , , , , , , , , , , , , , Total 1,16 10,94 6A 14 of 68

15 Demog r aphic Information 6B 15 of 68

16 Demog r aphic Information INCIDENTS AND CASE FATALITY BY AGE AND GENDER 7 CASE FATALITY RATE (NK/NR) <1 year,50 4, ,564, ,156, ,90, ,905, ,890, ,84, ,668, ,59, ,405, ,00, ,79, ,98, ,9 4, ,671 5, ,10 5, ,854 7, ,184 8, ,54 9, ,55 10, Total 4,00 89, ,10 1 DEATHS (NK/NR) CASE FATALITY RATE (MALE) (MALE) DEATHS DEATHS (NK/NR) (FEMALE) (MALE) CASE FATALITY RATE (FEMALE) (FEMALE) AGE 16 of 68

17 Demog r aphic Information 7A 7B 17 of 68

Demog r aphic Information ALCOHOL USE 8 ALCOHOL USE No (confirmed by test) 1,4 16.14 No (not suspected, not tested) 5,97 6.

18 Demog r aphic Information ALCOHOL USE 8 ALCOHOL USE No (confirmed by test) 1, No (not suspected, not tested) 5, Yes (confirmed by test [beyond legal limit]),871.9 Yes (confirmed by test [trace levels]),9.57 Not Applicabale 7, NK/NR 40, ,16 10 Total 8 18 of 68

Demog r aphic Information DRUG USE 9 DRUG USE No (confirmed by test) 11,57 8.76 No (not suspected, not tested) 51,84 9.

19 Demog r aphic Information DRUG USE 9 DRUG USE No (confirmed by test) 11, No (not suspected, not tested) 51,84 9. Yes (confirmed by test [illegal use drug]) 7, Yes (confirmed by test [prescription drug]) 1, Not Applicable 14, NK/NR 45, ,16 10 Total 9 19 of 68

20 Demog r aphic Information PRIMARY PAYMENT SOURCE 10 PRIMARY PAYMENT SOURCE 9, Medicaid 1,485.8 Self Pay 1, Blue Cross/Blue Shield 9, Other 6, No Fault Automobile 4, Other Government, Not Applicable, Not Billed (for any reason) Workers Compensation Medicare , ,16 10 NK/NR Total 10 0 of 68

21 I n j u r y Ch a r a c t e r i s t i c s Injury Characterisitics 1 of 68

22 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS AND CASE FATALITY RATE BY MECHANISM OF INJURY 11 MECHANISM DEATHS CASE FATALITY RATE Motor Vehicle Traffic 7, ,1.8 Fall 7, Struck by, against 1, Transport, other 10, Firearm 7, Cut/pierce 5, Pedal cyclist, other 4, Other specified and classifiable, Hot object/substance, Fire/flame 1, Natural/environmental, Bites and stings 1, Unspecified 1, Pedestrian, other Other specified, not elsewhere classifiable Machinery Natural/environmental, Other Overexertion NK/NR Suffocation Drowning/submersion , ,94 Poisoning Total Adverse effects have been removed from all mechanism tables, therefore percentages may not equal 100. of 68

23 I n j u r y Ch a r a c t e r i s t i c s 11A 11B of 68

24 I n j u r y Ch a r a c t e r i s t i c s SELECTED MECHANISMS OF INJURY BY AGE 1 AGE MOTOR VEHICLE TRAFFIC FALL STRUCK BY, AGAINST TRANSPORT, OTHER FIREARM CUT/PIERCE <1 year 491 4, , , , , , , , , , , , ,014 1, ,65 1, ,741 1,54 1, ,491 1,460 1,80 1, ,947 1,81 1,1 1, ,971 1,17 1, , ,9 1,09 1, ,78 1, ,05 1,7 1, ,906 1,100 Total 7,550 7,440 1,45 10,07 7,69 5,9 1 4 of 68

25 I n j u r y Ch a r a c t e r i s t i c s CASE FATALITY RATE BY MECHANISMS OF INJURY AND AGE 1 AGE STRUCK BY, TRANSPORT, CUT/PIERCE FALL CASE MVT CASE FIREARM CASE AGAINST CASE OTHER CASE CASE FATALITY FATALITY RATE FATALITY RATE FATALITY RATE FATALITY RATE FATALITY RATE RATE <1 year of 68

26 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS AND CASE FATALITY RATE BY MECHANISM OF INJURY AND GENDER 14 CASE FATALTY RATE (FEMALE) CASE FATALITY RATE (MALE) (FEMALE) (MALE) Motor Vehicle Traffic Fire/flame Transport, other Struck by, against Machinery Other specified and classifiable Pedal cyclist, other Drowning/submersion Hot object/substance Natural/environmental, Other Unspecified Firearm NK/NR Pedestrian, other Other specified, not elsewhere classifiable Overexertion Natural/environmental, Bites and stings Fall Suffocation Poisoning Cut/pierce MECHANISM Total Adverse effects have been removed from all mechanism tables, therefore percentages may not equal of 68

27 I n j u r y Ch a r a c t e r i s t i c s 14A 14B 7 of 68

I n j u r y Ch a r a c t e r i s t i c s INCIDENTS BY COMPARATIVE INJURY SEVERITY SCORES 15 LOCAL ISS ICD90 DERIVED AIS DERIVED ISS 1-8 69,755 5.79 78,571 59.47 71,15 5.

28 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS BY COMPARATIVE INJURY SEVERITY SCORES 15 LOCAL ISS ICD90 DERIVED AIS DERIVED ISS , , , , , , , , , >4 8, , , NK/NR 5, , , , , ,16 10 Total 15 8 of 68

29 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS AND CASE FATALITY RATE BY INJURY SEVERITY SCORE 16 ISS , , , >4 5, , NK/NR 9, ,16 10,94 Total DEATHS CASE FATALITY RATE 16 9 of 68

30 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS BY INJURY SEVERITY SCORE AND AGE 17 ISS 1-8 ISS 9-15 ISS 16-4 ISS >4 ISS NK/NR Total <1 year,880 86, ,7 1 4, ,, ,554, ,854 4, ,611 5, ,851 6, ,575 7, ,68 8, ,991 9, ,864 10, ,80 11, ,5 1,688 1, ,69 1,01 1, ,504 14,819 1, , ,494 1, , ,4,16 1, , ,97,46 1, , ,69,99 1, ,10 1,0 19 6,854,007 1, ,484 Total 78,571,564 15,17 5,940 9,74 1, of 68

31 I n j u r y Ch a r a c t e r i s t i c s CASE FATALITY RATE BY INJURY SEVERITY SCORE AND AGE 18 AGE ISS ISS 1-8 ISS 9-15 ISS 16-4 ISS >4 ISS NK/NR ISS 1-8 CASE ISS 9-15 CASE ISS 16-4 CASE ISS >4 CASE NK/NR CASE DEATHS FATALITY DEATHS FATALITY DEATHS FATALITY DEATHS FATALITY DEATHS FATALITY RATE RATE RATE RATE RATE <1 year Total of

32 I n j u r y Ch a r a c t e r i s t i c s 18 of 68

33 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS AND CASE FATALITY RATE BY WORK-RELATED INJURIES 19 WORK-RELATED DEATHS CASE FATALITY RATE Yes No 10, ,97.5 7, , ,16 10,94 Not Applicable NK/NR Total 19A of 68

34 I n j u r y Ch a r a c t e r i s t i c s 19B 4 of 68

35 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS AND CASE FATALITY RATE BY INTENT 0 INTENT 15, Other Self-inflicted Undetermined , , ,16 10,94 Assault Unintentional NK/NR Total DEATHS CASE FATALITY RATE COUNT 0 5 of 68

I n j u r y Ch a r a c t e r i s t i c s INCIDENTS AND CASE FATALITY RATE BY LOCATION E-CODE 1 LOCATION E-CODE Farm DEATHS CASE FATALITY RATE 910 0.69 1 1.4 7,065 8.05 700 1.89 659 0.50 10 1.5 18 0.

36 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS AND CASE FATALITY RATE BY LOCATION E-CODE 1 LOCATION E-CODE Farm DEATHS CASE FATALITY RATE , Other 5, Public Building 6, , Street 45, ,55.41 Unspecified 1, , ,16 100,94 Home Industry Mine Recreation Residential Institution Not Applicable NK/NR Total 1 6 of 68

I n j u r y Ch a r a c t e r i s t i c s INCIDENTS BY AIS BODY REGION AIS BODY REGION Head 44,989 4.05 Upper Extremity 7,5 8.0 Lower Extremity 5,476 6.85 Face 1,470.

37 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS BY AIS BODY REGION AIS BODY REGION Head 44, Upper Extremity 7,5 8.0 Lower Extremity 5, Face 1,470.8 Abdomen 18, Thorax 17, External 14, Spine 1, Neck 1, NK/NR 5, Total Incidents 1,16 A patient can have injuries in multiple body regions. 7 of 68

38 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS WITH AIS BY AIS BODY REGION AIS BODY REGION Head 1, Thorax 1, Lower Extremity 8, Abdomen 4, Upper Extremity, Spine 1, External Neck Face Total Incidents 1,16 A patient can have injuries in multiple body regions. 8 of 68

I n j u r y Ch a r a c t e r i s t i c s INCIDENTS AND CASE FATALITY RATE BY AIS BODY REGION 4 AIS BODY REGION DEATHS Head 44,989 1,950 4. Upper Extremity 7,5 657 1.76 Lower Extremity 5,476 768.

39 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS AND CASE FATALITY RATE BY AIS BODY REGION 4 AIS BODY REGION DEATHS Head 44,989 1, Upper Extremity 7, Lower Extremity 5, Face 1, Abdomen 18, Thorax 17,50 1, External 14,1 7.1 Spine 1, Neck 1, NK/NR 5, ,16,94 Total Incidents CASE FATALITY RATE A patient can have injuries in multiple body regions. 4 9 of 68

40 I n j u r y Ch a r a c t e r i s t i c s INCIDENTS BY PROTECTIVE DEVICES 5 PROTECTIVE DEVICES None 7, Lap Belt 10, Shoulder Belt 9, Helmet (e.g. bicycle, skiing, motorcycle) 8, Airbag Present 6, Child Restraint (booster seat, child car seat), Protective Clothing (e.g., padded leather pants) 1, Other 1, Personal Floatation Device Eye Protection NK/NR 1,091.5 Not Applicable 8, Protective Non-Clothing Gear (e.g., shin guard) Total Incidents 1, of 68

41 Outcomes Outcomes 41 of 68

Outcomes MEDIAN TOTAL EMS LENGTH (IN MINS) BY MECHANISM OF INJURY 6 MECHANISM MEDIAN 18,96 46 Fall 8,90 51 Struck by, against,779 46 Firearm,70 0 Transport, other,6 6 Cut/pierce,011 5 Pedal cyclist,

42 Outcomes MEDIAN TOTAL EMS LENGTH (IN MINS) BY MECHANISM OF INJURY 6 MECHANISM MEDIAN 18,96 46 Fall 8,90 51 Struck by, against, Firearm,70 0 Transport, other,6 6 Cut/pierce,011 5 Pedal cyclist, other 1,1 48 Other specified and classifiable 1, Hot object/substance Fire/flame Pedestrian, other Unspecified 8 44 Natural/environmental, Bites and stings Other specified, not elsewhere classifiable Machinery Natural/environmental, Other Overexertion Suffocation Drowning/submersion 55 4 Poisoning Motor Vehicle Traffic NK/NR 6 4 of 68

43 Outcomes MEDIAN TOTAL EMS LENGTH (IN MINS) BY INJURY SEVERITY SCORE 7 ISS MEDIAN 1-8, , ,005 5 >4,05 46 NK/NR 4, of 68

Outcomes MEDIAN LENGTH OF STAY (IN DAYS) BY MECHANISM OF INJURY 8 MECHANISM MEDIAN Motor Vehicle Traffic 7,494 Fall 7,9 1 Struck by, against 1,46 Transport, other 10,194 Firearm 7,619 Cut/pierce 5,1

44 Outcomes MEDIAN LENGTH OF STAY (IN DAYS) BY MECHANISM OF INJURY 8 MECHANISM MEDIAN Motor Vehicle Traffic 7,494 Fall 7,9 1 Struck by, against 1,46 Transport, other 10,194 Firearm 7,619 Cut/pierce 5,1 Pedal cyclist, other 4,558 Other specified and classifiable,96 Hot object/substance,749 Fire/flame 1,547 Natural/environmental, Bites and stings 1,505 Unspecified 1,41 Pedestrian, other 74 Other specified, not elsewhere classifiable 698 Machinery 59 Natural/environmental, Other 56 Overexertion 51 NK/NR 75 1 Suffocation 158 Drowning/submersion Poisoning 8 44 of 68

45 Outcomes MEDIAN LENGTH OF STAY (IN DAYS) BY INJURY SEVERITY SCORE 9 ISS MEDIAN , , ,01 4 >4 5,97 6 NK/NR 9, of 68

Outcomes MEDIAN VENTILATOR DAYS BY MECHANISM OF INJURY 0 MECHANISM Motor Vehicle Traffic MEDIAN,76 5 Firearm 64 4 Transport, other 411 5 Other specified and classifiable 85 5 Fall 74 4 Struck by,

46 Outcomes MEDIAN VENTILATOR DAYS BY MECHANISM OF INJURY 0 MECHANISM Motor Vehicle Traffic MEDIAN,76 5 Firearm 64 4 Transport, other Other specified and classifiable 85 5 Fall 74 4 Struck by, against 1 4 Fire/flame Cut/pierce 98 Unspecified 57 7 Pedal cyclist, other 5 4 Pedestrian, other 41 6 Hot object/substance 7 7 Suffocation 6 Drowning/submersion 1 6 Other specified, not elsewhere classifiable 9 5 Machinery 1 5 Natural/environmental, Other Natural/environmental, Bites and stings 14 Poisoning 6.5 Overexertion NK/NR 0 46 of 68

47 Outcomes MEDIAN VENTILATOR DAYS BY INJURY SEVERITY SCORE 1 ISS ,571 4 >4 1, NK/NR MEDIAN 1 47 of 68

Outcomes MEDICAN ICU DAYS BY MECHANISM OF INJURY MECHANISM MEDIAN Machinery 7,097 4 Fall,045 Firearm 1,56 4 Transport, other 1,490 Struck by, against 1,041 Other specified and classifiable 789 4

48 Outcomes MEDICAN ICU DAYS BY MECHANISM OF INJURY MECHANISM MEDIAN Machinery 7,097 4 Fall,045 Firearm 1,56 4 Transport, other 1,490 Struck by, against 1,041 Other specified and classifiable Cut/pierce 89 Pedal cyclist, other 7 Hot object/substance 58 4 Fire/flame 89 7 Unspecified 16 Pedestrian, other 1 Natural/environmental, Other 96 Other specified, not elsewhere classifiable 78 7,097 4 Natural/environmental, Bites and stings 70 Suffocation 57 Drowning/submersion 41 5 Poisoning 10 9 Motor Vehicle Traffic Overexertion NK/NR 48 of 68

49 Outcomes MEDIAN ICU DAYS BY INJURY SEVERITY SCORE ISS MEDIAN 1-8,5 9-15, ,76 >4,56 6 NK/NR, of 68

Outcomes INCIDENTS BY ED DISCHARGE DISPOSITION 4 ED DISCHARGE DISPOSITION Floor bed (general admission, non specialty unit bed) 5,91 40.8 Intensive Care Unit (ICU),511 17.04 Operating Room 18,410 1.

50 Outcomes INCIDENTS BY ED DISCHARGE DISPOSITION 4 ED DISCHARGE DISPOSITION Floor bed (general admission, non specialty unit bed) 5, Intensive Care Unit (ICU), Operating Room 18, Home without services 15, Transferred to another hospital 6, Telemetry/step-down unit (less acuity than ICU), Observation unit (unit that provides <4 hour stays), Died 1, Other (jail, institutional care facility, mental health, etc) Left against medical advice Home with services Not Applicable,9.44 NK/NR, ,16 10 Total 4 50 of 68

Outcomes REASONS FOR DEATH IN ED 5 DIED IN ED DOA: Declared dead on arrival with minimal or no resuscitation attempt 58 8.

51 Outcomes REASONS FOR DEATH IN ED 5 DIED IN ED DOA: Declared dead on arrival with minimal or no resuscitation attempt Death after failed resuscitation attempt (failure to respond within 15 minutes) Died in ED (other than failed resuscitation attempt) Total, of 68

52 Outcomes INCIDENTS BY HOSPITAL DICHARGE DISPOSITION 6 HOSPITAL DISCHARGE DISPOSITION 94, Discharged/Transferred to another type of rehabilitation or long term care,.45 Discharge/Transferred to home under care of Home Health Agency, Expired 1, Discharged/Transferred to another acute care hospital using EMS 1, Discharged/Transferred to an Intermediate Care Facility 1, Discharged/Transferred to Skilled Nursing Facility Left against medical advice , , ,16 10 Discharged home with no home services Discharged/Transferred to hospice care Not Applicable NK/NR Total 6 5 of 68

53 Outcomes INCIDENTS BY HOSPITAL COMPLICATIONS 7 COMPLICATIONS 1, Acute respiratory distress syndrome (ARDS) Cardiac arrest with CPR Coagulopathy Base deficit Systemic sepsis Deep Vein Thrombosis (DVT) / thrombophlebitis Decubitus ulcer Organ/space surgical site infection Extremity compartment syndrome Intracranial pressure Bleeding Acute renal failure Coma Superficial surgical site infection Unplanned intubation Pulmonary embolism Abdominal compartment syndrome Drug or alcohol withdrawal syndrome Wound disruption Stroke / CVA Graft/prosthesis/flap failure Deep surgical site infection 0.0 Abdominal fascia left open Myocardial infarction No NTDS listed Medical Complications Occurred 59, Not Applicable 44,67.81 NK/NR 4, Pneumonia Total Complications 14,091 Total Incidents 1,16 5 of 68

54 Outcomes 7 54 of 68

55 R e g i o n a l A n a lys e s Regional Analyses 55 of 68

R e g i o n a l A n a lys e s INCIDENTS BY REGION 8 REGION MIDWEST 4,160 5.

56 R e g i o n a l A n a lys e s INCIDENTS BY REGION 8 REGION MIDWEST 4, NORTHEAST 0, SOUTH 48, WEST 9,461.0 Total 1, of 68

57 R e g i o n a l A n a lys e s CASE FATALITY RATE BY REGION 9 REGION DEATHS CASE FATALITY RATE MIDWEST 4, NORTHEAST 0, SOUTH 48, WEST 9, Total 1, of 68

58 R e g i o n a l A n a lys e s MECHANISM OF INJURY BY REGION 40 MIDWEST NORTHEAST SOUTH WEST Motor Vehicle Traffic 7, Fall 7, Struck by, against 1, Transport, Other 10, Fire/flame 7, Cut/pierce 5, Pedal cyclist, Other 4, Other specified, not elsewhere classifiable, Hot object/substance, Firearm 1, Natural/environmental, Bites and stings 1, Unspecified 1, Pedestrian, Other Other specified and classifiable Machinery Natural/environmental, Other Overexertion NK/NR Suffocation Drowning/submersion , REGION Poisoning Total Adverse effects have been removed from all mechanism tables, therefore percentages may not equal of 68

59 R e g i o n a l A n a lys e s of 68

R e g i o n a l A n a lys e s INJURY SEVERITY SCORE BY REGION 41 MIDWEST NORTHEAST ISS 1-8 78,571 60.76 61.15 60. 55.40 9-15,564 16.16 17.0 17.

60 R e g i o n a l A n a lys e s INJURY SEVERITY SCORE BY REGION 41 MIDWEST NORTHEAST ISS , , , >4 5, NK/NR 9, , Total SOUTH WEST of 68

61 R e g i o n a l A n a lys e s INCIDENTS BY URBAN INFLUENCE CODE REGION 4 URBAN CATEGORY Rural 6, Suburban 4, Urban 55, Wilderness 1,9.80 Total 68, of 68

62 R e g i o n a l A n a lys e s CASE FATALITY RATE BY URBAN INFLUENCE CODES 4 URBAN CATEGORY DEATHS CASE FATALITY RATE Rural 6, Suburban 4, Urban 55,094 1,4.4 Wilderness 1, Total 68,744 1, of 68

63 R e g i o n a l A n a lys e s 44 MECHANISM OF INJURY BY URBAN INFLUENCE CODES MECHANISM (RURAL) (RURAL) (WILDERNESS) (WILDERNESS) Motor Vehicle Traffic 16, ,58.74, Fall 15, , , Struck by, against 5, Firearm, Transport, other, Cut/pierce, Pedal cyclist, other 1, Hot object/substance 1, Other specified and classifiable 1, Natural/environmental, Bites and stings Fire/flame Unspecified Pedestrian, other Other specified, not elsewhere classifiable Overexertion Machinery Natural/environmental, Other Suffocation Drowning/submersion Poisoning , , , ,9 100 NK/NR Total (URBAN) (URBAN) (SUBURBAN) (SUBURBAN) 6 of 68

64 R e g i o n a l A n a lys e s of 68

65 R e g i o n a l A n a lys e s INJURY SEVERITY SCORE BY URBAN INFLUENCE CODES 45 ISS (URBAN) 1-8, , , , , , , >4, NK/NR, , , , ,9 10 Total (URBAN) (SUBURBAN) (SUBURBAN) (RURAL) (RURAL) (WILDERNESS) (WILDERNESS) of 68

66 Appendix A Appendices 66 of 68

67 Appendix A Definition of Trauma Patient Definition of Trauma Patient adopted by NATIONAL TRAUMA DATA BANK (NTDB) At least one of the following injury diagnostic codes defined in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM): Excluding the following isolated injuries: (late effects of injury) (superficial injuries, including blisters, contusions, abrasions, and insect bites) (foreign bodies) AND MUST INCLUDE ONE OF THE FOLLOWING IN ADDITION TO (ICD-9-CM ): Hospital admission as defined by your trauma registry inclusion criteria; OR Patient transfer via EMS transport (including air ambulance) from one hospital to another hospital; OR Death resulting from the traumatic injury (independent of hospital admission or hospital transfer status) 67 of 68

68 Appendix B E-Code Grouping Recommended Framework for E-Code Groupings for Presenting Injury Mortality and Morbidity Data. Reference MMWR 1997;46:1 0. Updated last time in 009. MECH A NI S M /C AU S E M A NNER / IN T EN T UNINTENTIONAL CUT/PIERCE DROWNING/SUBMERSION FALL FIRE/BURN FIRE/FLAME HOT OBJECT/SUBSTANCE FIREARM MACHINERY MOTOR VEHICLE TRAFFIC, OCCUPANT MOTORCYCLIST PEDAL CYCLIST PEDESTRIAN UNSPECIFIED PEDAL CYCLIST, OTHER PEDESTRIAN, OTHER TRANSPORT, OTHER NATURAL/ENVIRONMENTAL BITES AND STINGS OVEREXERTION POISONING STRUCK BY, AGAINST SUFFOCATION OTHER SPECIFIED AND CLASSIFIABLE4 OTHER SPECIFIED, NOT ELSEWHERE CLASSIFIABLE UNSPECIFIED ALL INJURY SELF-INFLICTED ASSAULT UNDETERMINED E E80.0.9, E8.0.9 E E880.0 E886.9, E888 E890.0 E899, E E890.0 E899 E E9.0.,.8,.9 E919 (.0.9) E810 E819 (.0.9) E810 E819 (.0,.1) E810 E819 (.,.) E810 E819 (.6) E810 E819 (.7) E810 E819 (.9) E800 E807 (.) E80 E85 (.6), E86.1,.9 E87 E89(.1) E (.) E80 E85(.7) E86 E89(.0) E800 E807 (.0,.1,.8,.9) E80 E85 (.0.5,.8,.9) E86..8 E87 E89 (..9), E81.0.9, E8.0 E845.9 E900.0 E909, E98.0. E ,.9 E ,.5,.9 E ,.8,.9 E850.0 E869.9 E916 E917.9 E911 E91.9 E846 E848, E914 E915 E918, E91.0.9, E9.4,5 E9.0.9, E95.0 E96.9 E98., E E98.8, E99.8 E956 E954 E966 E964 E986 E984 E E958.1,.,.7 E958.1 E958.,.7 E E968.1 E961, E968.0,. E968.0 E961, E968. E E E988.1,.,.7 E988.1 E988.,.7 E E958.5 E968.5 E988.5 E958.6 E988.6 E958. E988. E950.0 E95.9 OTHER1 E974 E970 E980.0 E98.9 E958.8, E959 E E960.0; E968. E96 E960.1, E E , E968.4,.6,.7 E E968.8, E969 E887, E98.9, E99.9 E958.9 E968.9 E988.9 E977, E995, E997.8 E998, E999 E976, E997.9 E800 E869, E880 E99 E950 E959 E960 E969, E979 E980 E989 E970 E978, E990 E999 E E955.5,.6,.7,.9 E958.0,.4 E E985.5,.6,.7 E988.0,.4 E988.8, E989 ADVERSE EFFECTS E97 E97, E975 E971, E978, E990 E994, E996 E MEDICAL CARE E870 E879 E90.0 E949.9 E870 E879 DRUGS E90.0 E949.9 ALL EXTERNAL CAUSES E800 E999 1 Includes legal intervention (E970 E978) and operations of war (E990 E999). Three 4th-digit codes (.4 [occupant of streetcar],.5 [rider of animal],.8 [other specified person]) are not presented separately because of small numbers. However, because they are included in the overall motor vehicle traffic category, the sum of these categories can be derived by subtraction. E968.5 (assault by transport vehicle), E906.5 (bite from unspecified animal), E9.4 (unintentional injury [gunshot wound] with BB/pellet), E955.6 (suicide attempt/intentionally Self-inflicted injury [gunshot wound] with BB/pellet gun), E968.6 (assault [gunshot wound] with BB/pellet gun), E985.6 (undetermined intent injury [gunshot wound] with BB/pellet gun), E98. (unintentional human bite), and E968.7 (assault by human bite), are specific to the ICD-9-CM and, therefore, only apply to morbidity coding. 4 E849 (place of occurrence) has been excluded from the matrix. For mortality coding, an ICD-9 E849 code does not exist. For morbidity coding, an ICD-9-CM E849 code should never be first the listed E- code and should only appear as an additional code to specify the place of occurrence of the injury incident. 68 of 68

National Trauma Data Bank 2008 Pediatric Report

National Trauma Data Bank 2008 Pediatric Report Version 8.0 Acknowledgments The American College of Surgeons Committee on Trauma wishes to thank the Centers for Disease Control and Prevention (CDC) for