The Bureau of Emergency Medical Services (BEMS) requires all designated trauma hospitals to participate in the state trauma registry system.

There are four objectives of the trauma registry: performance improvement, hospital operations, injury prevention, and medical research. Of the four, performance improvement is the primary reason for maintaining a trauma registry. If utilized appropriately, performance improvement can be done in a much more efficient manner than if done manually. Secondly, the registry can help in managing resource utilization through daily logs, summaries, etc. Also, a requirement of all designated trauma centers in Mississippi is to participate in some way in injury control activities (injury prevention). The registry helps to identify injury control issues at the local, regional, and state levels. Finally, by all designated facilities capturing standardized data, the information can be used in clinical research. This will be done primarily at the state level.

The state registry system is designed primarily to collect data on only those patients with serious injuries. It is also designed to identify system issues, such as over and under triage, at the regional and state levels. In order to track these patients effectively, BEMS has identified criteria for a patient to be included in the registry at the local level. This is the inclusion criterion that is REQUIRED for all designated trauma centers. ALL CENTERS MUST INCLUDE, AT A MINIMUM, ALL PATIENTS THAT MEET THESE CRITERIA. This is regardless of payment source, indigent status, etc. This is the data that a trauma center must capture in order to maintain an effective trauma program.

All state designated patients must have a primary diagnosis of ICD-9 diagnosis code 800-959.9 in addition to any one of the following:

• Transferred between acute care facilities (in or out)
• Admitted to critical care unit (no minimum)
• Hospitalization for three or more calendar days
• Died after receiving any evaluation or treatment
• Admitted directly from Emergency Department to Operating Room for major procedure, excluding plastics or orthopedics procedures on patients that do not meet the three day hospitalization criteria
• Triaged (per regional trauma protocols) to a trauma hospital by pre-hospital care regardless of severity
• Treated in the Emergency Department by the trauma team regardless of severity of injury

The following primary ICD-9 diagnosis codes are excluded and should NOT be included in the trauma registry:

• ICD9Code 905-909 (Late effects of injuries)
• ICD9Code 930-939 (Foreign bodies)
• Extremities and/or hip fractures from same height fall in patients over the age of 65.

I. Utilization of the Trauma Registry by a Designated Trauma Care Center

The Bureau of Emergency Medical Services (BEMS) requires all designated trauma hospitals to participate in the state trauma registry system. There are four objectives of maintaining the trauma registry. These are performance improvement, hospital operations, injury prevention, and medical research. Of the four, performance improvement is the primary reason for maintaining a trauma registry. If utilized appropriately, performance improvement can be done in a much more efficient manner than if done manually. Secondly, the registry can help in managing resource utilization through daily logs, summaries, etc. Also, a requirement of all designated trauma centers in Mississippi is to participate in injury control activities (injury prevention). The registry helps to identify injury control issues at the local, regional, and state levels. Finally, by all designated facilities capturing standardized data, the information can be used in clinical research.

The state registry system is designed primarily to collect data on only those patients with serious injuries. It is also designed to identify system issues, such as over and under triage, at the regional and state levels. In order to track these patients effectively, BEMS has identified criteria for a patient to be included in the registry at the local level. This is the inclusion criterion that is REQUIRED for all designated trauma centers. ALL CENTERS MUST INCLUDE, AT A MINIMUM, ALL PATIENTS THAT MEET THESE CRITERIA. This is regardless of payment source, indigent status, etc. This is the data that a trauma center must capture in order to maintain an effective trauma program. Please note, that this is the MINIMUM requirement for a trauma center to capture. It is recommended that all hospitals evaluate their patient population and identify if it would benefit the trauma program to expand the inclusions criteria to include more than what is required by the state. This is acceptable and encouraged. However, on the discharge screen of the registry, those patients that do not meet the definition of a State Designated Patient should be marked ‘NO' in the State Designated field. This will keep those patients not meeting state inclusion criteria from being downloaded to the state registry.

II. Prerequisite for a State Designated Trauma Registry Patient

All state designated patients must have a primary diagnosis of ICD-9 diagnosis code 800-959.9 and meet at least one of the other requirements. Exclusions to this rule are as follows:

• ICD9Code 905-909 (Late effects of injuries)
• ICD9Code 930-939 (Foreign bodies)
• Extremities and/or hip fractures from same height fall in patients over the age of 65.

If the primary diagnosis falls within the range of 905-909 or 930-939, they should not be included. These injuries do not have an AIS value associated with them, making it impossible to calculate an Injury Severity Score (ISS). If a patient has any of these injuries, secondary to a qualifying primary diagnosis, then they should be included and documented, along with any other injuries, burns, etc.

The trauma registry is designed to evaluated serious injuries caused by mechanical forces. For this reason, isolated injuries, such as extremities and/or hip fractures from same height fall in patients over the age of 65, are excluded. This will primarily be seen in elderly patients who suffer from the injury not because of the event, but because of osteoporosis. Some of these may have to be evaluated and may come down to clinical judgment. Also, trauma hospitals may want to collect this information for reasons internally. This is recommended, if the volume is manageable by the facility. However, it is not a requirement of the state.

III. Inclusions requirements after prerequisite

After a patient meets the prerequisite requirements for inclusions, they must meet any one of the following.

1. Transferred between acute care facilities (In or out)

   If a trauma center receives a patient that has sustained an injury that the center is unable to treat and transfers the patient to a higher or more appropriate level of care, this patient must be included in the registry at both the transferring and receiving hospital. This will allow regions to identify over and under triage that is occurring.

2. Admitted to intensive care (no minimum)

   Any injury sustained that warrants admission to ICU must be included.

3. Hospitalization for three or more calendar days

   Any patient hospitalized for three or more calendar days must be included. In some situations, patients may be hospitalized for reasons other than the injury, i.e. medical, social, etc. It is recommended that hospitals include all of these for evaluation in their own facility, but only those hospitalized due to the injury should be submitted to the state.

4. Died after receiving any evaluation or treatment

   All trauma deaths that receive any evaluation or treatment in the Emergency Department must be entered in the registry and evaluated for preventability at all levels: pre-hospital, transferring hospital, and receiving hospital.

5. Admitted directly from Emergency Department to Operating Room for major procedure, excluding plastics or orthopedics procedures on patients that do not meet the three day hospitalization criteria

   All patients that are admitted directly from the ED to the operating room for a major procedure must be included. Any plastic and/or orthopedic procedures that do not meet one of the other criteria for inclusion must not be entered into the trauma registry.

6. Triaged (per regional trauma protocols) to a trauma hospital by pre-hospital care regardless of severity

   If any patient is triaged to a trauma center by pre-hospital care providers (per regional trauma protocols), the patient must be included in the registry. This is how medical direction for pre-hospital care at the local and regional levels will monitor appropriateness of triage protocols.

7. Treated in the emergency department by the trauma team regardless of severity of injury

   Any trauma patient triaged or transferred into a trauma center that results in the activation of the trauma team must be entered into the registry. This will allow a hospital's trauma program manager to monitor appropriateness of trauma team activation protocols.

IV. Criteria for Including Burn Patients into the Trauma Registry Special note for coding injuries for burn patients (ICD-9-CM 940-949)

The ICD-9 codes for burn patients are 940.00 – 949.00. To be able to calculate an ISS for burn patients, you MUST code the injury under the 948.00 sub-classification group. This pertains to burns classified according to extent of body surface involved. This is the only group of ICD9 codes for burns that give an AIS value. No other burn ICD-9 codes should be included into the trauma registry.