Slide 1 - American College of Surgeons

NTDB ® Annual Report 2008 © American College of Surgeons 2008. All Rights Reserved Worldwide

National Trauma Data Bank 2008Pediatric Report

Version 8.0


NTDB Annual Report 2008

EditorsAvery B. Nathens, 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 StaffMelanie Neal, Manager

Sandra Goble, StatisticianChrystal Price, Coordinator

National Trauma Data Bank Subcommittee

Palmer Q. Bessey, MD, FACSKaren J. Brasel, MD, FACSDavid E. Clark, MD, FACSArthur Cooper, MD, FACS

Joseph Cuschieri, MD, FACSRichard J. Fantus, MD, FACS

Jeffrey S. Hammond, MD, FACSRichard J. Kagan, MD, FACS

Geoffrey R. Keyes, MD, FACSMichael D. McGonigal, MD, FACSFrederick H. Millham, MD, FACS

Allen F. Morey, MD, FACSCharles E. Morrow, Jr., MD, FACS

Michael L. Nance, MD, FACSAvery B. Nathens, MD, PhD, FACS

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

N. Clay Mann, PhD, MS, Consultant

Pediatric Surgery Subspecialty GroupArthur Cooper, MD, FACS, Chair

Guy Brisseau, MD, FACSCharles S. Cox, MD, FACSMary E. Fallat, MD, FACSHenri R. Ford, MD, FACS

William D. Hardin, MD, FACSRichard J. Jackson, MD, FACSDavid P. Mooney, MD, FACSMichael L. Nance, MD, FACS

Kennith H. Sartorelli, MD, FACSL. R. Scherer, MD, FACS

Perry W. Stafford, MD, FACS


AcknowledgmentsThe American College of Surgeons Committee on Trauma wishes to thank the Centers for Disease Control and Prevention (CDC) for their support of the NTDB.


Please note:The abbreviation NK/NR used on many tables denotes Not Known, Not Recorded, or Blank. If Not Applicable is not shown as a separate row on the table, then it is also included in the NK/NR category.

“Local ISS” denotes ISS scores submitted directly by hospitals regardless of the method of calculation. “ICD90 Derived” are scores derived by converting ICD9 codes to AIS using the ICD 90 Mapping program and then calculating ISS with the resulting AIS severity scores. “AIS Derived” are calculated from AIS submitted directly by hospitals. Analyses in this report use the ICD 90 Derived ISS.


Incidents by AgeFigure

1A

Incidents by Age

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Age

Num

ber


Case Fatality Rate by AgeFigure

1B

Case Fatality Rate by Age

0.000.501.001.502.002.503.003.504.004.50

Age

Case

Fat

ality

Rat

e (%

)


Incidents by Age and GenderFigure

2A

Incidents by Age and Gender

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

Age

Perc

ent

Female Male


Case Fatality Rate by Age and GenderFigure

2B

Case Fatality Rate by Age and Gender

01122334455

Age

Case

Fat

ality

Rat

e (%

)

Female Male


Alcohol Use

0.005.00

10.0015.0020.0025.0030.0035.0040.0045.0050.00

No (confirmedby test)

No (notsuspected, not

tested)

Yes (confirmedby test [beyond

legal limit])

Yes (confirmedby test [trace

levels])

Not Applicable NK/ NR

Perc

ent

Figure3

Alcohol Use


Drug Use Figure4

Drug Use

0.00

10.00

20.00

30.00

40.00

50.00

60.00

No (confirmedby test)

No (notsuspected, not

tested)

Yes (confirmedby test [illegal

use drug])

Yes (confirmedby test

[prescriptiondrug])

Not Applicable NK/ NR

Perc

ent


Primary Payment SourceFigure5

Primary Payment Source

0.005.00

10.0015.0020.0025.0030.00

Perc

ent


Incidents by Mechanisms of InjuryFigure

6A

Incidents by Mechanism of Injury

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

Motor VehicleTraffic

Fall Struck by,against

Transport,other

Firearm Cut/ pierce

Mechanism of Injury

Perc

ent


Case Fatality Rate by Mechanism of InjuryFigure

6B

Case Fatality Rate by Mechanism of Injury

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00



Transport,other

Firearm Cut/pierce

Mechanism of Injury

Case

Fat

ality

Rat

e (%

)


Incidents by Mechanisms of Injury by AgeFigure7

Incidents by Mechanism of Injury by Age

0

1,000

2,000

3,000

4,000

5,000

6,000

<1year

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Age

Num

ber

Motor Vehicle Traffic Fall Struck by, against Transport, Other Firearm Cut/ pierce


Case Fatality Rate by Mechanism of Injury and Age

Figure8

Case Fatality Rate by Mechanism of Injury and Age

0.0010.0020.0030.0040.0050.00

<1year

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Age

Case

Fat

ality

Rat

e (%

)

MVT Fall Struck by, against Transport, Other Firearm Cut/pierce


Incidents by Mechanism of Injury and GenderFigure

9A

Incidents by Mechanism of Injury and Gender

0.005.00

10.0015.0020.0025.0030.0035.0040.0045.00

MotorVehicleTraffic


Transport,other

Firearm Cut/ pierce

Mechanism of Injury

Perc

ent

Female Male


Case Fatality Rate by Mechanism of Injury and Gender

Figure

9B

Case Fatality Rate by Mechanism of Injury and Gender

0.002.004.006.008.00

10.0012.0014.00

MotorVehicleTraffic


Transport,other

Firearm Cut/ pierce

Mechanism of Injury

Case

Fat

ality

Rat

e (%

)

Female Male


Incidents by Comparative Injury Severity Scores

Figure10

Incidents by Comparative Injury Severity Scores

0.0010.0020.0030.0040.0050.0060.0070.00

1–8 9–15 16–24 >24 NK/ NRInjury Severity Score

Perc

ent

Local ISS ICD90 Derived AIS Derived


Case Fatality Rate by Injury Severity ScoreFigure11

Case Fatality Rate by Injury Severity Score

0.00

5.00

10.00

15.00

20.00

25.00

30.00

1–8 9–15 16–24 >24 NK/ NRISS Categories

Case

Fat

ality

Rat

e (%

)


Incidents by Injury Severity Score and AgeFigure12

Incidents by Injury Severity Score and Age

01,0002,0003,0004,0005,0006,0007,000

<1year

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Age

Num

ber o

f Cas

es

1-8 9-15 16-24 >24 NK/ NR


Case Fatality Rate by Injury Severity Score and Age

Figure13

Case Fatality Rate by Injury Severity Score and Age

0.0010.0020.0030.0040.0050.0060.00

<1year

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Age

Case

Fat

ality

Rat

e (%

)

ISS 1 –8 Case Fatality ISS 9–16 Case Fatality ISS 16–24 Case FatalityISS >24 Case Fatality NK/ NR Case Fatality


Incidents by Work-Related InjuriesFigure

14A

Incidents by Work-Related Injuries

0.0010.0020.0030.0040.0050.0060.0070.0080.00

Yes No Not Applicable NK/ NR

Perc

ent


Case Fatality Rate by Work-Related InjuriesFigure

14B

Case Fatality Rate by Work Related Injuries

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Yes No Not Applicable NK/ NR

Case

Fat

ality

Rat

e (%

)


Case Fatality Rate by IntentFigure

15

Case Fatality Rate by Intent

0.002.004.006.008.00

10.0012.0014.00

Assault Self-inflicted Undetermined Unintentional Other NK/ NR

Case

Fat

ality

Rat

e (%

)


Case Fatality Rate by Location E-codeFigure16

Case Fatality Rate by Location E-code

0.000.501.001.502.002.503.003.504.004.50

Farm HomeIndustry

Mine OtherPublic Building

Recreation

Residential Institution

StreetUnspecified

Not Applicable

NK/NR

Case

Fat

ality

Rat

e (%

)


Incidents by AIS Body RegionFigure

17

Incidents by AIS Body Region

-5.00

10.0015.0020.0025.0030.0035.0040.00

HeadFace Neck Thorax

AbdomenSpine

Upper Extremity

Lower Extremity

ExternalNK/ NR

Perc

ent


Incidents by AIS ≥ 3 by AIS Body RegionFigure

18

Incidents with AIS ≥ 3 by Body Region

-10.0020.0030.0040.0050.0060.00

Perc

ent


Case Fatality Rate by AIS Body RegionFigure

19

Case Fatality Rate by AIS Body Region

-2.004.006.008.00

10.0012.00

HeadFace Neck Thorax

AbdomenSpine

Upper Extremity

Lower Extremity

ExternalNK/NR

Case

Fat

ality

Rat

e (%

)


Incidents by Protective DevicesFigure

20

Incidents by Protective Devices

-5.00

10.0015.0020.0025.0030.00

NoneShoulder Belt

Lap BeltAirbag Present

Helmet (e.g. bicycle, skiing, motorcycle)

OtherProtective Clothing (e.g., padded leather pants)

Child Restraint (booster seat, child car seat)

Protective Non-Clothing Gear (e.g., shin guard)

Eye Protection

Personal Floatation Device

Not Applicable

NK/ NR

Protective Devices

Perc

ent


Median Total EMS Length (Mins) by Mechanism of Injury

Figure

21

Median Total EMS Length (Mins) by Mechanism of Injury

010203040506070

MVT Fall Struck by, against

Transport, other

FirearmCut/ pierce

Pedal cyclist, other

Hot object/substance

Other specified and classifiable

Fire/ flame

Unspecified

Natural/ environmental, Bites and stings

Pedestrian, other

Mechanism of Injury

Num

ber o

f Min

utes


Median Total EMS Length (Mins) by Injury Severity Score

Figure

22

Median Total EMS Length (Mins) by ISS

42

44

46

48

50

52

1-8 9-15 16-24 >24

Injury Severity Score

Num

ber

of M

inut

es


Median Length of Stay (Days) by Mechanism of Injury

Figure

23

Median Length of Stay (Days) by Mechanism of Injury

011223

MVT Fall

Struck b

y, again

st

Transport, ot

herFire

armCut/ p

ierce

Pedal cyclist

, other

Hot objec

t/ substance

Mechanism of Injury

Num

ber o

f Day

s


Median Length of Stay (Days) by Injury Severity ScoreFigure

24

Median Length of Stay (in Days) by Injury Severity Score

01234567

1–8 9–15 16–24 >24


Num

ber o

f Day

s


Median Ventilator Days by Mechanisms of Injury

Figure

25

Median Ventilator Days by Mechanism of Injury

02468

101214

MVT Fall

Struck b

y, against

Transport,

other

Firearm

Cut/ pierc

e

Pedal cyc

list, other

Hot objec

t/substa

nce

Other specified and

classifiable

Fire/flame

Mechanism of Injury

Num

ber o

f Day

s


Median Ventilator Days by Injury Severity ScoreFigure

26

Median Ventilator Days by Injury Severity Score

01234567

1–8 9–15 16–24 >24


Num

ber o

f Day

s


Median ICU Days by Mechanism of InjuryFigure

27

Median ICU Days by Mechanism of Injury

0

1

2

3

4

5

6

MVTFall

Struck by, against

Transport, other

FirearmCut/pierce

Pedal cyclist, other

Hot object/substance

Other specified and classifiable

Fire/flame

Unspecified

Mechanism of Injury

Num

ber o

f Day

s


Median ICU Days by Injury Severity ScoreFigure

28

Median ICU Days by Injury Severity Score

01234567

1–8 9–15 16–24 >24


Num

ber o

f Day

s


Incidents by ED Discharge DispositionFigure

29

Incidents by ED Discharge Disposition

0.005.00

10.0015.0020.0025.0030.0035.0040.00

Died Floor bed (general admission, non specialty unit bed)

Home with services

Home without services

Intensive Care Unit (ICU)

Left against medical advice

Observation unit (unit that provides < 24 hour stays)

Operating Room

Other (j ail, institutional care facility, mental health, etc)

Telemetry/ step–down unit

Transferred to another hospital

NK/ NR

ED Discharge Disposition

Perc

ent


Reasons for Death in EDFigure

30

Reasons for Death in ED

-100200300400500600700800

DOA: Declared dead onarrival with minimal or

no resuscitation

Death after failedresuscitation attempt(no response within 15

minutes)

Died in ED (other thanfailed resuscitation

attempt)

Num

ber


Incidents by Hospital Discharge DispositionFigure

31

Incidents by Hospital Discharge Disposition

0.0010.0020.0030.0040.0050.0060.0070.0080.0090.00

Discharge/ Transferred to home under care of Home...

Discharged home with no home services

Discharged/ Transferred to Skilled Nursing Facility

Discharged/ Transferred to an Intermediate Care Fac...

Discharged/ Transferred to another acute care hospi...

Discharged/ Transferred to another type of rehabilit...

Discharged/ Transferred to hospice care

ExpiredLeft against medical advice

Not Applicable

NK/ NR

Hospital Discharge Disposition

Perc

ent


Incidents by Hospital ComplicationsFigure

32

Incidents by Hospital Complications

0.00

0.20

0.40

0.60

0.80

1.00

1.20

Pneumonia

Acute respiratory distress syndrome (ARDS)

Deep vein thrombosis (DVT) / thrombophlebitis

Acute renal failure

Systemic sepsis

Cardiac arrest with CPR

Coagulopathy

Decubitus ulcer

Drug or alcohol withdrawal syndrome

Pulmonary embolism

Complications

Perc

ent


Incidents by RegionFigure

33

Incidents by Region

0.005.00

10.0015.0020.0025.0030.0035.0040.00

Midwest Northeast South West

Region

Perc

ent


Case Fatality Rate by RegionFigure

34

Case Fatality Rate by Region

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50


Region

Case

Fat

ality

Rat

e (%

)


Mechanism of Injury by RegionFigure

35

Mechanism of Injury by Region

0.00

10.00

20.00

30.00

40.00



Transport,other

Mechanism of Injury

Perc

ent



Injury Severity Score by RegionFigure

35

Injury Severity Score by Region

0.0010.0020.0030.0040.0050.0060.0070.00

1–8 9–15 16–24 >24


Perc

ent



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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Slide 1 - American College of Surgeons

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