Annual Report 2016: Almost a 10

The Annual Report 2016 of the National Trauma Data Bank® (NTDB®) is an updated analysis of the largest aggregation of U.S trauma registry data ever assembled. The NTDB now contains close to 7.5 million records. The Annual Report 2016 is based on 861,888 records with valid trauma diagnoses from the single admission year of 2015 from 747 facilities, including 239 Level I trauma centers, 263 Level II trauma centers, and 196 Level III or IV trauma centers; 36 are Level I or Level II pediatric centers.

Use of ICD-10 in report development

The International Classification of Diseases (ICD), owned and published by the World Health Organization, is the world-standard diagnostic tool for health management, epidemiology, and clinical purposes. The ICD is used to monitor incidence and prevalence of diseases and other health care problems.* In 2009, the U.S. Department of Health and Human Services published a regulation requiring U.S. providers to transition from the ninth edition of the classification system (ICD-9) to ICD-10, which is what the rest of the world was using.

ICD-10 has several advantages over its predecessor. Some trauma-related highlights include expanded injury codes, a combination of diagnosis/symptom codes to reduce the number of codes necessary to describe a condition, and two additional characters added along with subclassifications allowing laterality and greater specificity in code assignment. This transition required a significant change in institutional infrastructure throughout the U.S. Consequently, the final date of implementation was delayed until October 1, 2016.As a transitional year, this annual report allows the inclusion of both ICD-9 and ICD-10 codes (see Table 1).

Table 1. Differences between ICD-9-CM and ICD-10-CM code sets

ICD-9-CM ICD-10-CM
3 to 5 characters in length 3 to 7 characters in length
Approximately 13,000 codes Approximately 68,000 current codes
First character may be alpha (E or V) or numeric; characters 2–5 are numeric Character 1 is alpha; characters 2 and 3 are numeric; characters 4–7 are alpha or numeric
Limited space for new codes New codes can be added
Limited code detail Specific code detail
No laterality Includes laterality

Purpose of report

The mission of the American College of Surgeons (ACS) Committee on Trauma (COT) is to develop and implement meaningful programs for trauma care. In keeping with this objective, the NTDB is committed to being the principal national repository for trauma center data. The purpose of this report is to inform the medical community, the public, and decision makers about a range of issues that characterize the current state of care for injured persons. It has implications for many areas, including epidemiology, injury control, research, education, acute care, and resource allocation.

Many dedicated individuals on the ACS COT, as well as at trauma centers around the country, have contributed to the early development of the NTDB and its rapid growth in recent years. Building on these achievements, the goals in the coming years include improving data quality, updating analytic methods, and enabling more useful interhospital comparisons. These efforts will be reflected in future NTDB reports to participating hospitals, as well as in the annual reports.

Throughout the year, we will be highlighting these data through brief reports that are published monthly in the Bulletin. The NTDB Annual Report 2016 is available on the ACS website as a PDF file on the ACS website. In addition, information is available on the website about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org.


*World Health Organization. Classifications. Available at: www.who.int/classifications/icd/en/. Accessed November 18, 2016.

World Health Organization. International Classification of Diseases, Tenth Revision, Clinical Modification. Available at: www.cdc.gov/nchs/icd/icd10cm.htm. Accessed November 18, 2016.

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