NTDB ® Annual Report 2007 © American College of Surgeons 2007. All Rights Reserved Worldwide.

NTDB ® Annual Report 2007 © American College of Surgeons 2007. All Rights Reserved Worldwide


NTDB Annual Report 2007

EditorsDavid E. Clark, MD, FACS, Chair Richard J. Fantus, MD, FACS, Chair

National Trauma Data Bank Subcommittee Trauma Registry Advisory Ad Hoc Committee

American College of Surgeons Committee on Trauma LeadershipJohn J. Fildes, MD, FACS J. Wayne Meredith, MD, FACS Chair,

Committee on Trauma Medical Director, Trauma OfficeDivision of Research and Optimal Patient Care

National Trauma Data Bank SubcommitteePalmer Q. Bessey, MD, FACS

Karen J. Brasel, MD, FACSArthur Cooper, MD, FACS

Joseph Cuschieri, MD, FACSJeffrey S. Hammond, MD, FACS

Michael D. McGonigal, MD, FACSGeoffrey R. Keyes, MD, FACS

Sidney F. Miller, MD, FACSFrederick H. Millham, MD, FACS

Charles E. Morrow, Jr., MD, FACSAvery B. Nathens, MD, FACS

Arthur L. Ney, MD, FACSRonald D. Robertson, MD, FACS

Manoj R. Shah, MD, FACSGlen H. Tinkoff, MD, FACS

N. Clay Mann, PhD, MS, Consultant

National Trauma Data Bank StaffMelanie Neal, Manager

Sandra Goble, StatisticianChrystal Price, Coordinator


AcknowledgmentsThe American College of Surgeons Committee on Trauma wishes to thank the Health Resources and Services Administration (HRSA), the National Highway Traffic Safety Administration (NHTSA), and the Centers for Disease Control and Prevention (CDC) for their support of the NTDB.


States and U.S Territories submitting data to the NTDB. Number of hospitals in the state that have submitted to the NTDB divided by the number of hospitals identified by the Trauma Exchange Information Program (TIEP) as trauma centers designated by a state or local authority and/or verified by the American College of Surgeons.

Figure 1: States and U.S. Territories Submitting to the NTDB

67% or greater34% to 66%0% to 33%


Figure 2A: Percentage of Hospitals by Bed Size

N=712

Percentage of Hospitals by Bed Size

0

5

10

15

20

25

30

35

<=200 201–400 401–600 >600 Missing

Bed Size

Per

cen

t


Figure 3A: Percentage of Hospitals by Level of Designation

N=712

Percentage of Hospitals by Level of Designation

0

5

10

15

20

25

30

35

40

45

I II III IV Missing

Level of Designation

Per

cen

t


Figure 4A: Number of Incidents by Year

Number of Incidents by Year

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Admission Year

Nu

mb

er

of

Inc

ide

nts

Records in annual report

Not in annual report


Number of Incidents by Source of Payment

0

50,000

100,000

150,000

200,000

250,000

300,000

Nu

mb

er o

f In

cid

ents

Other

Self Pay

Medicare

Managed CareOrganization

Medicaid

Not Done/Not Documented

Other CommercialIndemnity Plan

Automobile Insurance

Blue Cross/Blue Shield

Worker's Compensation

No Charge

Figure 5A: Number of Incidents by Source of Payment


Figure 6A: Number of Incidents by Age

Number of Incidents by Age

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

1 8 15 22 29 36 43 50 57 64 71 78 85 92 99 106

Age (years)

Nu

mb

er o

f In

cid

ents


Figure 7A: Number of Incidents by Age and Gender

Number of Incidents by Age and Gender

0

5,000

10,000

15,000

20,000

25,000

30,000

0 6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 102

Age (years)

Nu

mb

er o

f In

cid

ents

Males

Females


Figure 8A: Case Fatality Rate by Age

Case Fatality Rate by Age

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

0 10 20 30 40 50 60 70 80

Age (years)

Ca

se

Fa

talit

y R

ate


Figure 9A: Case Fatality Rate by Age and Gender

Case Fatality Rate by Age and Gender

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

0 10 20 30 40 50 60 70 80

Age (years)

Ca

se

Fa

talit

y R

ate

Males

Females


Figure 10A: Number of Incidents by Mechanism of Injury

Number of Incidents by Mechanism of Injury

0

100,000

200,000

300,000

400,000

500,000

600,000

Mot

or ve

hicle

traffic Fall

Struck

by,

again

st

Trans

port,

othe

r

Firearm

Cut/pier

ce

Other

spec

ified an

d cla

ssifia

ble

Pedal

cycli

st, o

ther

Fire/b

urn

Mac

hiner

y

Mechanism of Injury

Nu

mb

er o

f In

cid

ents


Figure 11A: Number of Deaths by Mechanism of Injury

Number of Deaths by Mechanism of Injury

0

100,000

200,000

300,000

400,000

500,000

600,000

Moto

r veh

icle

traf

fic Fall

Struck

by,

agai

nst

Transp

ort, o

ther

Firear

m

Cut/pie

rce

Oth

er s

pecifi

ed an

d cla

ssifi

able

Pedal

cyc

list,

other

Fire/b

urn

Mac

hiner

y

Unspec

ified

Mechanism of Injury

Nu

mb

er o

f D

eath

s


Figure 12A: Average Hospital Length of Stay by Mechanism of Injury

Average Hospital Length of Stay by Mechanism of Injury

0.00.5

1.01.5

2.02.5

3.03.5

4.04.5

5.0

Mot

or ve

hicle

traffic Fall

Struck

by,

again

st

Trans

port,

othe

r

Firearm

Cut/pier

ce

Other

spec

ified an

d cla

ssifia

ble

Pedal

cycli

st, o

ther

Fire/b

urn

Mac

hiner

y

Mechanism of Injury

Av

era

ge

Ho

sp

ita

l LO

S in

Da

ys


Figure 13A: Average ICU Length of Stay by Mechanism of Injury

Average ICU Length of Stay by Mechanism of Injury

0.00.51.01.52.02.53.03.54.04.55.0

Moto

r veh

icle t

raffic Fall

Struck

by, a

gains

t

Trans

port,

othe

r

Firear

m

Cut/p

ierce

Other

spec

ified a

nd cl

assif

iable

Pedal

cycli

st, ot

her

Fire/b

urn

Mac

hiner

y

Mechanism of Injury

Ave

rag

e IC

U L

OS

in

Day

s


Figure 14A: Number of Incidents for Selected Mechanisms of Injury by Age

Number of Incidents for Selected Mechanisms of Injury by Age

0

5,000

10,000

15,000

20,000

25,0000 8 16 24 32 40 48 56 64 72 80

Age

Nu

mb

er o

f In

cid

ents

MVT

Fall

Struck by, against

Firearms

Transport, Other


Figure 15A: Case Fatality Rate for Selected Mechanisms of Injury by Age

Case Fatality Rate for Selected Mechanisms of Injury by Age

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

0 6 12 18 24 30 36 42 48 54 60 66 72 78 84

Age

Cas

e F

atal

ity

Rat

e

MVT

Fall

Struck by, against

Firearms

Transport, Other


Figure 16A: Percentage of Incidents by Injury Severity Score

Percentage of Incidents by Injury Severity Score

0

5

10

15

20

25

30

35

40

45

50

1–8 9–15 16–24 >24

Injury Severity Score

Per

cen

t


Figure 17A: Number of Incidents by Injury Severity Score (ISS) and Age

Number of Incidents by Injury Severity Score (ISS) and Age

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

0 10 20 30 40 50 60 70 80

Age (years)

Nu

mb

er

of

Incid

en

ts

ISS 1–8

ISS 9–14

ISS 15–24

ISS>24


Figure 18A: Case Fatality Rate by Injury Severity Score

Case Fatality Rate by Injury Severity Score

0

5

10

15

20

25

30

35

1–8 9–15 16–24 >24


Case F

ata

lity

Rate


Figure 19A: Average Hospital Length of Stay by Injury Severity Score

Average Hospital Length of Stay by Injury Severity Score

0

2

4

6

8

10

12

14

16

1–8 9–15 16–24 >24


Le

ng

th o

f S

tay

in D

ay

s


Figure 20A: Average ICU Length of Stay by Injury Severity Score

Average ICU Length of Stay by Injury Severity Score

0

1

2

3

4

5

6

7

8

1–8 9–15 16–24 >24


Ave

rag

e IC

U L

OS

in

Day

s


Figure 21A: Number of Incidents by Intent

Number of Incidents by Intent

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

Unintentional Assault Self-inflicted Undetermined Other

Intent

Num

ber

of In

cide

nts


Figure 22A: Case Fatality Rate by Intent

Case Fatality Rate by Intent

0

2

4

6

8

10

12

14

16

18

20

Unintentional Assault Self-inflicted Undetermined Other

Intent

Ca

se

Fa

talit

y R

ate


Figure 23A: Percentage of Incidents by Type of Injury

Percentage of Incidents by Type of Injury

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Blunt Penetrating Burn Missing

Type of Injury

Per

cen

t


Figure 24A: Case Fatality Rate by Type of Injury

Case Fatality Rate by Type of Injury

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Blunt Penetrating Burn Missing

Type of Injury

Cas

e F

atal

ity

Rat

e


Figure 25A: Percentage of Incidents by Organ System

Percentage of Incidents by Organ System

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Abdomen Brain/Skull Extremity Pelvic Spine Thorax

Organ System

Per

cen

t

Note: An incident may involve multiple organ systems and a patient will then be counted in each of the organ systems in which there is an injury.


Figure 26A: Case Fatality Rate by Organ System

Case Fatality Rate by Organ System

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Abdomen Brain/Skull Extremity Pelvic Spine Thorax

Organ System

Cas

e F

atal

ity

Rat

e

Note: An incident may involve multiple organ systems and a patient will then be counted in each of the organ systems in which there is an injury. The case fatality rate is calculated as the number of deaths in each organ system divided by the number of incidents in that organ system. No inferences should be drawn from these data with respect to causality, since the NTDB contains no specific information on proximate cause of death, but only those injuries associated with death.


Figure 27A: Percentage of Incidents with Brain/Skull Injuries

Percentage of Incidents with Brain/Skull Injuries

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

Brain Only Brain and Skull Skull Only

Head Injury

Per

cen

t Note: An incident may involve multiple head injuries and a patient will then be counted in each of the head injury categories in which there is an injury


Figure 28A: Case Fatality Rate for Brain/Skull Injuries

Case Fatality Rate for Brain/Skull Injuries

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Brain Only Brain and Skull Skull Only

Head Injury

Cas

e F

atal

ity

Rat

eNote: The case fatality rate is calculated as the number of deaths in each head injury category divided by the total number of incidents for that head injury category. No inferences should be drawn from these data with respect to causality, since the NTDB contains no specific information on proximate cause of death, but only those injuries associated with death.


Figure 29A: Percentage of Incidents with Intracranial Injuries

Percentage Incidents with Intracranial Injuries

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Other Brain Injury Only Subdural/Extradural HemorrhageOnly

Subdural/Extradural Hemorrhageand Other Brain Injury

Intracranial Injury

Per

cen

t


Figure 30A: Case Fatality Rate for Intracranial Injuries

Case Fatality Rate for Intracranial Injuries

0.0

5.0

10.0

15.0

20.0

25.0

Other Brain Injury Only Subdural/Extradural HemorrhageOnly

Subdural/Extradural Hemorrhageand Other Brain Injury

Intracranial Injuries

Cas

e F

atal

ity R

ate

Note: The case fatality rate is calculated as the number of deaths in each intracranial category divided by the number of incidents per category. No inferences should be drawn from these data with respect to causality, since the NTDB contains no specific information on proximate cause of death, but only those injuries associated with death.


Figure 31A: Percentage of Incidents with Thoracic Injuries

Percentage of Incidents with Thoracic Injuries

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

ChestWall/Diaphragm

Heart Lungs TracheobronchialTree/Esophagus

Thoracic Injuries

Per

cen

t Note: An incident may involve multiple thoracic injuries and a patient will then be counted in each of the thoracic injury categories in which there is an injury.


Figure 32A: Case Fatality Rate for Thoracic Injuries

Case Fatality Rate for Thoracic Injuries

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

ChestWall/Diaphragm

Heart Lungs TracheobronchialTree/Esophagus

Other

Thoracic Injuries

Cas

e F

atal

ity

Rat

eNote: An incident may involve multiple thoracic injuries and a patient will then be counted in each of the thoracic injury categories in which there is an injury. The case fatality rate is calculated as the number of deaths in each thoracic injury category divided by the number of incidents. No inferences should be drawn from these data with respect to causality, since the NTDB contains no specific information on proximate cause of death, but only those injuries associated with death.


Figure 33A: Percentage of Incidents with Abdominal Injuries

Percentage of Incidents with Abdominal Injuries

0.0

0.5

1.0

1.5

2.0

2.5

3.0

GI Tract GenitourinaryTract

Liver Spleen Other

Abdominal Injury

Per

cen

t

Note: An incident may involve multiple abdominal injuries and a patient will then be counted in each of the abdominal injury categories in which there is an injury.


Figure 34A: Case Fatality Rate for Abdominal Injuries

Case Fatality Rate for Abdominal Injuries

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

GI Tract GenitourinaryTract

Liver Spleen Other

Abdominal Injury

Cas

e F

atal

ity

Rat

e

Note: An incident may involve multiple abdominal injuries and a patient will then be counted in each of the abdominal injury categories in which there is an injury. The case fatality rate is calculated as the number of deaths in each abdominal injury category divided by the number of incidents in each category. No inferences should be drawn from these data with respect to causality, since the NTDB contains no specific information on proximate cause of death, but only those injuries associated with death.


Note: 111 hospitals with designation level I submitted data.

Figure 35A: Number of records submitted with a 2006 admission year per facility for Level I hospitals


Note: 117 hospitals with designation level II submitted data.

Figure 35B: Number of records submitted with a 2006 admission year per facility for Level II hospitals


Figure 35C: Number of records submitted with a 2006 admission year per facility for Level III or IV hospitals

Note: 46 hospitals with designation level III or IV submitted data.


Figure 36A: Data Completeness per Facility. Proportion of records included in the annual report with a 2006 admission year from Level I hospitals

Note: For a record to be included in the annual report, the following fields must be valid and non missing: Date of Birth, Gender, E-Code, Injury Severity Score, Length of Stay, Discharge Disposition/ Discharge Status, and valid diagnosis code according to NTDB inclusion criteria. Nine out of 111 facilities had 0% of the records qualifying, and are not visible in the graph.


Figure 36B: Data Completeness per Facility. Proportion of records included in the annual report with a 2006 admission year from Level II hospitals

Note: For a record to be included in the annual report, the following fields must be valid and non missing: Date of Birth, Gender, E-Code, Injury Severity Score, Length of Stay, Discharge Disposition/ Discharge Status, and valid diagnosis code according to NTDB inclusion criteria. Six out of 117 facilities had 0% of the records qualifying, and are not visible in the graph.


Figure 36C: Data Completeness per Facility. Proportion of records included in the annual report with a 2006 admission year from Level III or V hospitals

Note: For a record to be included in the annual report, the following fields must be valid and non missing: Date of Birth, Gender, E-Code, Injury Severity Score, Length of Stay, Discharge Disposition/ Discharge Status, and valid diagnosis code according to NTDB inclusion criteria. One out of 46 facilities had 0% of the records qualifying, and are not visible in the graph.


Figure 37A: Case fatality rate (%) per facility for all records with 2006 admission year from Level I hospitals

Note: Nine out of 111 facilities reported a case fatality rate of 0 %, and are not visible on the graph.


Figure 37B: Case fatality rate (%) per facility for all records with 2006 admission year from Level II hospitals

Note: Fourteen out of 117 facilities reported a case fatality rate of 0 %, and are not visible on the graph.


Figure 37C: Case fatality rate (%) per facility for all records with 2006 admission year from Level III or IV hospitals

Note: Ten out of 46 facilities reported a case fatality rate of 0 %, and are not visible on the graph.


Resources

• www.ntdb.org for more information about NTDB

• www.ntdbdatacenter.com to transmit data to NTDB

• www.ntdsdictionary.org for information on the new data standard

http://www.ntdb.org/

http://www.ntdbdatacenter.com/

http://www.ntdsdictionary.org/

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