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Reducing the Burden of Injury: Advancing Prevention and Treatment
grams for prehospital and acute care providers. Finally, the committee believes that there are financial incentives for employers, insurers, and others who pay for health care to adopt injury prevention, a point discussed later in the section on health care financing.
Surveillance data from trauma systems are indispensable for monitoring outcomes, assessing system performance, determining the etiology and scope of the injury problem in a community, and influencing public policy. Yet no nationwide or nationally representative surveillance systems are operational for trauma systems as a whole nor for their separate elements (i.e., prehospital, acute care, and rehabilitation services). Most surveillance systems currently in place are kept by individual trauma centers as a condition of trauma center designation (Pollock and McClain, 1989).2 In addition, although 48 percent of states have some type of hospital-based trauma registries, there is great variability in their nature, scope, purpose, and data elements (Shapiro et al., 1994). To instill greater uniformity, federal agencies and professional organizations have taken the initiative to develop and encourage the use of a variety of uniform data sets from prehospital, acute care, and rehabilitation providers. Working with the EMS community, NHTSA sponsored a conference in 1993, the final product of which was a proposed set of 81 uniform prehospital EMS data elements, either essential or desirable, for patient severity and treatment, cause of injury, response, and transfer times, but not for outcomes (under the rationale that these would have required linkages to the emergency department) (U.S. DOT, 1994). CDC's National Center for Injury Prevention and Control (NCIPC) supported the development of a uniform data set for 24-hour, hospital-based emergency departments, the Data Elements for Emergency Department Systems (DEEDS) (NCIPC, 1997a). The ACS developed, specifically for trauma centers, the National Trauma Data Bank to serve as a voluntary national repository of data from trauma centers. The Uniform Data System for Medical Rehabilitation was developed with support from the National Institute on Disability and Rehabilitation Research to capture the severity of patient disability and the outcomes of rehabilitation.
A number of states and regions have implemented laws that mandate inclusive trauma systems with comprehensive trauma registries. These registries include data retrieved from prehospital services, police and ambulance records, hospitals, rehabilitation centers, and medical examiners' files. These data systems are driven by E-codes (see Chapter 3) and have disease- and severity-specific information, as well as length of stay, morbidity and mortality, and charge information. Linkages between data sets covering prehospital, acute care, and rehabilitation providers are envisioned as a pivotal means of integrating information across trauma systems nationwide and of formulating public policy.
ACS criteria require Levels I–III to collect minimal registry data, whereas Level IV is encouraged, but not required, to maintain a registry.