Trauma data requirements in NSW
Mandate for trauma data in NSW
The mandate for the collection of trauma data in NSW derives from the NSW Trauma Services Plan1.
The NSW Trauma Services Plan requires NSW ITIM to monitor and report on the performance of individual Trauma Services to ensure that performance is consistent with the standard of care, and to manage a state-wide clinical injury data collection process.
The plan also positions NSW ITIM to develop partnerships with injury stakeholders in order to build an improved critical mass for research and education across the spectrum of trauma prevention care and rehabilitation. The collection of trauma data is an important aspect of these activities.
Scope of trauma data collection in NSW
The NSW Trauma Registry contains de-identified patient records submitted by trauma registries in NSW. The NSW Trauma Registry does not hold data for every injured person admitted to hospital in NSW. Data is only included for patients with the greatest needs – the most seriously injured – who are treated at a designated hospital in NSW which contributes to the NSW Trauma Registry. This data is known as the NSW Trauma Minimum Data Set, and forms the basis of data analysis and reporting activities at NSW ITIM. The trauma data collection tool for this dataset is described below.
As the scope of the current data collection is restricted to these designated hospitals there may be some data for trauma admissions to other hospitals which is not included in the NSW Trauma Registry. These numbers however are estimated to be small.
Criteria for inclusion in the NSW Trauma Minimum Data Set
All patients of any age, who were admitted to a designated NSW Trauma Service within 7 days of sustaining an injury, and:
- Had an Injury Severity Score (ISS) > 12 (moderate to critically injured); or
- Admitted to an Intensive Care Unit (irrespective of ISS) following injury; or
- Died in hospital (irrespective of ISS) following injury, except those with an isolated fractured neck of femur injury sustained from a fall from a standing height (<1 metre) and those aged 65 years or older who die with minor soft tissue injury only.
About the inclusion criteria
The key criterion for including a patient record in the NSW Trauma Registry is a classification of injuries as moderate to critical. This classification relies upon an internationally recognised anatomical scoring system known as the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS)2. The AIS and ISS is used by accredited staff at each hospital trauma service to score individual patient injuries and their severity, and provides a common tool for comparing and selecting patient records for inclusion in the NSW Trauma Registry.
Patients with injuries classified as moderate are identified for the NSW Trauma Registry when they have an Injury Severity Score of 13 or 14 (ISS 13,14).
Patients with injuries classified as serious to critical are identified for the NSW Trauma Registry when they have an Injury Severity Score of greater than 15 (ISS > 15).
For more information see the Injury scoring section.
As a result of the inclusion criteria, patient records in the NSW Trauma Registry do not represent all injuries in NSW (for example patients with minor injuries with an Injury Severity Score <13 are generally not included in the NSW Trauma Registry unless the patient is deceased), nor do they represent the full work or case-load of trauma teams in hospitals, or the full set of data recorded in hospital trauma registries.
The data is however, a very complete and accurate record of the moderate to critically injured group of patients. Data submitted for inclusion in the state-wide trauma registry is subject to rigorous checking and validation prior to inclusion in the registry, while missing or invalid data is flagged and returned to individual trauma services for completion. Missing data however is rare and the state-wide trauma registry has an extremely low incidence of incomplete records.
Overview of the Abbreviated Injury Score (AIS) and Injury Severity Score (ISS)
The Injury Severity Score (ISS) is an internationally recognised anatomical scoring system that provides an overall score for patients with multiple injuries. The ISS is a calculated number which is based on an anatomical injury severity classification, the Abbreviated Injury Scale (AIS). The AIS classifies individual injuries by body region on a 6 point severity scale from Minor to Maximum (currently untreatable injury). The ISS score correlates with mortality, morbidity and other measures of severity.
Scoring is undertaken retrospectively, but usually within 24-48 hours after admission to allow for identification of all injuries. On initial evaluation these patients typically have abnormal vital signs or a significant anatomical injury.
The calculated ISS value ranges from 1-75. Serious to critically injured trauma patients are defined as those patients with an ISS > 15, which is an internationally recognised indicator of serious injury. NSW ITIM often reports ISS in ranges: 13,14 (moderate injury), 16-24 (serious injury), 25-40 (severe injury) and 41-75 (critical injury).
The NSW Trauma Minimum Data Set
The NSW trauma minimum data set consists of a number of data elements (listed below). The data elements conform to state and national standards, including the Abbreviated Injury Scoring system and the International Classification of Diseases (ICD-10-AM/ACHI/ACS Sixth Edition).
The data points collected effective from 1 July 2017 are:
- Demographic – Recording Trauma Facility
- Demographic – Trauma Record Number
- Demographic – Facility Arrival Date / Time
- Demographic – Record Complete
- Demographic – System Access
- Demographic – Home Postcode
- Demographic – Age
- Demographic – Gender
- Injury – Injury Date / Time
- Injury – Primary Injury Cause
- Injury – Primary Injury Type
- Injury – Place of Injury
- Injury – Activity when Injured
- Injury – Height of Fall
- Injury – Injury Location (Postcode)
- PreHosp – Scene/Transport Providers – Agency
- PreHosp – Scene/Transport Providers – Mode
- PreHosp – Scene/Transport Providers – Run Number
- PreHosp – Scene/Transport Providers – Call Received Date / Time
- PreHosp – Scene/Transport Providers – At Patient Date / Time
- PreHosp – Scene/Transport Providers – Left Location Date / Time
- PreHosp – Scene/Transport Providers – Was Patient Extracted
- PreHosp – Scene/Transport Providers – Time Required (for Patient Extraction)
- Ref Facility – Referring Facility Name (1 and 2)
- Ref Facility – Referring Facility 1 – Arrival Date and Time
- Ref Facility – Referring Facility 2 – Arrival Date and Time
- Ref Facility – Transfer Rationale (1 and 2)
- Ref Facility – Referring Facility Procedures – Procedure (1 and 2)
- Ref Facility – Inter-Facility Transport – Agency (1 and 2)
- Ref Facility – Inter-Facility Transport Agency (1) – Call Received Date / Time
- Ref Facility – Inter-Facility Transport Agency (2) – Call Received Date / Time
- Ref Facility – Inter-Facility Transport Agency (1) – Arrived at Patient Date / Time
- Ref Facility – Inter-Facility Transport Agency (2) – Arrived at Patient Date / Time
- Ref Facility – Inter-Facility Transport Mode (1 and 2)
- Pt Tracking – Location Tracking - Location
- Pt Tracking – Location Tracking – Arrival and Departure Date / Time
- Pt Tracking – Ventilator Tracking – Start and Stop Date / Time
- ED – ED Arrival Date / Time
- ED – ED Departure Date / Time
- ED – Trauma Response
- ED – Post ED Disposition
- Initial ED Vital Date / Time - Recorded
- Initial ED Vitals – Temperature
- Initial ED Vitals – Temperature Units
- Initial ED Vitals – Route for Temperature
- Initial ED Vitals – Intubated
- Initial ED Vitals – Intubation Method
- Initial ED Vitals – Paralytic Agents
- Initial ED Vitals – Sedated
- Initial ED Vitals – Respiration Assisted
- Initial ED Vitals – Respiration Type
- Initial ED Vitals – SaO2
- Initial ED Vitals – Pulse Rate
- Initial ED Vitals – Respiration Rate
- Initial ED Vitals – SBP/DBP
- Initial ED Vitals – GCS Eye
- Initial ED Vitals – GCS Verbal
- Initial ED Vitals – GCS Motor
- Initial ED Vitals – GCS Total
- Initial ED Vitals – RTS
- Procedures – Procedure Name
- Procedures – Start Date/Time
- Diagnosis – AIS Code/Description
- Diagnosis – AIS Body Region
- Diagnosis – Injury Severity Score (ISS)
- Diagnosis – TRISS
- Diagnosis – Pregnancy Status
- Outcome – Discharge Status
- Outcome – Discharge or Death Date/Time
- Outcome – Total ICU Days
- Outcome – Total Ventilator Days
- Outcome – Total Hospital Days
- Outcome – Discharged To
- Outcome – If Transferred, Facility and If Other, Facility Name
- Outcome – Transfer Rationale
- Outcome – Location of Death
- QA – QA Filter Code
- Abbreviated Injury Scale
- Injury Severity Score
- Injury scoring section
- Trauma data reports
- Support material for NSW Trauma Registry users
- The NSW Trauma Registry system
- Trauma data section
- NSW Health Department (2009) Selected Specialty and Statewide Services Plans Number Six. NSW Trauma Services Plan, North Sydney: NSW Health Department.
- Abbreviated Injury Scale 2005: Association for the Advancement of Automotive Medicine, 2005, p5