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. The website for the registry can be found at: https://patientregistry.imagetrend.com/iowa/. 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 on this website: https://www.facs.org/quality-programs/trauma/ntdb
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.
Figure 3. Screenshot of the ImageTrend Registry Diagnosis Search Box.
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:
Figure 4. Screenshot of the ImageTrend Registry Patient Diagnosis List by ICD-10 Diagnosis Code.
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
Complex Rupture Spleen
|
2
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. Information on the course can be found here: https://www.aaam.org/abbreviated-injury-scale-ais/training-courses/.
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.