The Trauma Registry is a comprehensive trauma database that includes a number of injury related data elements. These include emergency department visits, injury hospitalizations as well as a comprehensive data set for patients who have been severely injured Injury Severity Score (ISS >12).
Trauma registries play an important role in decreasing morbidity and mortality by providing accurate and comprehensive information on injury. It provides the necessary information to conduct quality assurance, injury surveillance, research and the development injury prevention and control strategies. This information aids administrators and clinicians in decision making for evidence-based care.
Trauma care can also be improved through the accumulation and assessment of local, regional, provincial and national trauma statistics. The main objective of the databases is to collate information collected from defined groups over time that may be used toward the:
- prevention or treatment of injury
- provision of care
- monitoring of changing patterns of disease or treatments
- evaluation and planning of services provided
The information collected includes information related to the injury event, patient demographics, the types and severity of injuries sustained in the event, the process of care (pre-hospital through discharge) and patient outcomes.
The following are some of the uses for trauma data:
- assisting with prioritizing trauma programming and care delivery resources
- planning injury prevention initiatives targeted to local and regional trends
- evaluating and improve the timeliness, appropriateness and quality of patient care
- providing a mechanism for comparing patient outcomes across service areas, provider groups
- providing data for clinical benchmarking, process improvement
- providing the capability to monitor trauma system trends
The Saint John Regional Hospital submitted data to the National Trauma Registry (Canadian Institute for Health Information) on trauma cases that had an Injury Severity Score (ISS) > 12 from 2000 to 2013. The Moncton Hospital also collected data for submission to the National Trauma Registry from 2011 to 2013. The National Trauma Registry closed as of March 31, 2014, although reports can still be accessed from the historical data.
To be included in the NTR CDS, cases also have to meet one of the following criteria:
- Were admitted to a participating hospital.
- Were treated in the emergency department of a participating hospital (not admitted).
- Died in the emergency department of a participating hospital after treatment was initiated (not admitted).
Examples of causes of injury that are excluded from this definition are poisonings by drugs and gases, adverse effects of drugs, medicinal and biological substances and late effects.
Injury Severity Score*
The Injury Severity Score (ISS) is an anatomical scoring system that provides an overall score for patients with multiple injuries. Each injury is assigned an Abbreviated Injury Scale (AIS) score and is allocated to one of six body regions (see chart below). Only the highest AIS score in each body region is used. The three most severely injured body regions have their score squared and added together to produce the ISS score.
An example of the ISS calculation is shown below:
Baker SP et al, “The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care”, J Trauma 14:187-196; 1974
The ISS score takes values from 0 to 75. If an injury is assigned an AIS of 6 (non-survivable injury), the ISS score is automatically assigned to 75. Weaknesses of this scoring system include any error in AIS scoring increases the ISS error. Many different injury patterns can yield the same ISS score and injuries to different body regions are not weighted.
Abbreviated Injury Scale (AIS)
A unique six-digit numerical codes that describes individual injuries, categorized in one of nine body regions. Each injury code is followed by a decimal point, and the AIS severity code of 1 – 6
*Information was adapted from http://www.trauma.org/.
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