Texas EMS/Trauma Registry · Texas Requires the Reporting of Injuries Texas Administration Code §103.1‐§103.8 1. EMS: all actions (trauma and medical) 2. Hospitals: major trauma

Texas EMS/Trauma Registry

Kristi Metzger PhD MPHEpidemiologist / Acting Manager

Texas Department of State Health ServicesInjury Epidemiology & Surveillance Branch

[email protected]

Texas Requires the Reporting of InjuriesTexas Administration Code §103.1‐ §103.8

1. EMS: all actions (trauma and medical) 2. Hospitals: major trauma injuries, including

deaths, admitted >48 hours, transfers 3. Spinal cord injuries (SCI) 4. Traumatic brain injuries (TBI) 5. Submersions

Hospital Trauma Data 2013113,358 injuries reported

23,624 (21%) of injuries due to Motor Vehicle/Traffic

0

2000

4000

6000

8000

10000

12000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

All Trauma

Motor Vehicle/Traffic

Includes hospital trauma data reported to the Texas EMS/Trauma Registry by 4/4/2014

EMS Trauma Data 2013325,167 trauma runs reported

67.133 (21%) of injuries are Motor Vehicle related

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

All Trauma

Motor Vehicle/Traffic

Includes hospital trauma data reported to the Texas EMS/Trauma Registry by 4/4/2014

Why Link Trauma Data?

• One database rarely has all information on a trauma event– Hospital data includes patient outcome, detail on injuries on most severe traumas

– EMS data includes immediate patient condition, emergency treatment, timing of response

– Crash data includes severity of crash, details on conditions surrounding crash, passenger information

Case Study of Linked RecordsEMS #1 Ryan Zilker (DOB: 11/11/1986) was in MVC in Comal County on 4/10/2010,

suffering blunt force trauma and possible head injuries; seat belt was used and air bag deployed; EMS unit A dispatched at 16:36, arrived on the scene at 16:47, provided treatment with oxygen, spinal stabilization, and IV fluids



EMS #2 Ryan Zilkerr (DOB: 11/10/1990) was in MVC in Comal County on 4/10/2010, with unspecified injuries to the face, thorax, and abdomen; EMS LifeFlight Unit B dispatched at 17:26, arrived on scene at 17:48, provided ALS assessment and treatment with oxygen; departed scene at 7:56 and transported to and arrived at hospital #1 at 18:14




Hospital #1 Ryan Zilker (DOB: 2/15/1991) was in MVC in Comal County on 4/10/2010, suffering lacerated spleen, lung contusion, and multiple fractures (2 ribs, scapula, clavicle). Discharged, with expected full recovery, on 4/17/2010





Crash #1 Ryan Zilker (DOB: 2/15/1991) was injured in a 2‐vehicle, 4‐person MVC on a ranch‐to‐market road in Comal County on 4/10/2010 at 16:40 in which he was the driver of one of the vehicles; he wore a seatbelt and his air bag deployed; he was not suspected of DUI. Weather conditions were clear. Speeding contributed to the crash. Of the other 3 passengers involved in the crash: 1 died, 1 had non‐incapacitating injuries, 1 was not injured. He was taken via LifeFlight to Hospital #1.

How Do We Link Data?

DETERMINISTIC LINKING• “Exact” matching

PROBABILISTIC LINKING• “Close” match based on

mathematical computation

FIRST LAST DOB DETERMINISTIC LINK

KRISTINA METZGER 05/06/1972 A


KRISTI METZGER 05/06/1972 B

KRISTI METZGER 06/05/1972 C

KRISTINA METZGERR 05/06/1972 D

FIRST LAST DOB PROBABALISTICLINK



KRISTI METZGER 05/06/1972 A

KRISTI METZGER 06/05/1972 A

KRISTINA METZGERR 05/06/1972 A

Data Validity Impacts Probabilistic Linking Algorithms

Variable Type Validity Issues Probabilistic LinkingText strings (e.g., names, address)

Misspellings, typographical errors, nicknames, transpositions, hyphenations

Use phonetic codes, partial matching, lists of knownnicknames, string comparisons

Dates(e.g., date of birth)

Transpositions, missing date parts

Use partial matching, checks for swapped parts

Categorical variables (e.g., sex, race/ethnicity)

Incorrect values, missing values

Use frequency‐based matching – adjust weights based on “commonness”






EMS data tells us immediate patient conditions, emergency treatment, timing of response – if more than one EMS unit was dispatched, both records may provide different information






Hospital data tells us patient outcome, detail on injuries – if patient was transferred from one hospital to another, the records may provide different information





Crash #1 Ryan Zilker (DOB: 2/15/1991) was injured in a 2‐vehicle, 4‐person MVC on a ranch‐to‐market road in Comal County on 4/10/2010 at 16:40 in which he was the driver of one of the vehicles; he wore a seatbelt and his air bag deployed; he was not suspected of DUI. Weather conditions were clear. Speedingcontributed to the crash. Of the other 3 passengers involved in the crash: 1 died, 1 had non‐incapacitating injuries, 1 was not injured. He was taken via LifeFlight to Hospital #1.

Crash data tells us about the severity of the crash, details on the conditions surrounding the crash, and passenger information

Epidemiology of Linked Trauma Data

• Example #1: How does response time (e.g., EMS arrival, transport to hospital, transport between hospitals) for MVC impact patient outcome?

• Example #2: How do factors surrounding MVC (e.g., speed, weather, road conditions, protective devices) impact patient outcome?

• Example #3: How does geographic location (e.g., rural vs. urban) of MVC impact patient outcome?

Future of Trauma Registry

• Compliance with national standards– Hospital data = NTDB– EMS data = NEMSIS

• Additional sources of trauma data– Pre‐EMS = first responders– Pre‐hospital = emergency departments– Post‐hospital = rehab, long‐term acute care facilities

• Data sharing among trauma services providers

www.dshs.state.tx.us/injury

Documents

Texas EMS/Trauma Registry · Texas Requires the Reporting of Injuries Texas Administration Code §103.1‐§103.8 1. EMS: all actions (trauma and medical) 2. Hospitals: major trauma